Ischemia Physiology STEMI 
Dr. Smith's ECG Blog
NOVEMBER 26, 2018
The axiom of "type 1 (ACS, plaque rupture) STEMIs are not tachycardic unless they are in cardiogenic shock" is not applicable outside of sinus rhythm. In some cases the ischemia can be seen "through" the flutter waves, whereas in other cases the arrhythmia must be terminated before the ischemia can be clearly distinguished.
Dr. Smith's ECG Blog
NOVEMBER 19, 2016
Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. DISCUSSION: The 12-lead EKG EMS initially obtained for this patient showed severe ischemia, with profound "infero-lateral" ST depression and reciprocal ST elevation in lead aVR.
Dr. Smith's ECG Blog
APRIL 20, 2019
There is sinus rhythm with minimal STE in V1-V3, not meeting STEMI criteria. V2 never has this appearance in the absence of full thickness ischemia. The delay between OMI and STEMI sometimes causes unacceptable loss of myocardium or worse. There is a small amount of reciprocal STD in V6 with a negative T-wave.
Dr. Smith's ECG Blog
DECEMBER 26, 2020
We have also shown several cases in which atrial flutter hides true, active ischemia. Is this inferor STEMI? Atrial Flutter with Inferior STEMI? The EM provider asked if the cardiologist thought it was a "STEMI." Christmas Eve Special Gift!! Prehospital Cath Lab Activation: What do you think? Tachycardia and ST Elevation.
Dr. Smith's ECG Blog
AUGUST 4, 2024
QOH versions 1 and 2 both say Not OMI, with high confidence, without any clinical context, despite the abnormal STE meeting STEMI criteria. Serial echo monitoring showed increasing pericardial pressures without overt tamponade physiology. That said — I did not interpret these differences as the result of acute ischemia.
EMS 12-Lead
MAY 8, 2022
The attending crews were concerned for SVT with corresponding ischemic hyperacute T waves (HATW) and subsequently activated STEMI pre-hospital. Then, three minutes later… Crews activated STEMI as she deteriorated into PEA arrest. Chapter 6: Introduction to Myocardial Ischemia and Infarction. Physiology. 2] Birnbaum, Y.,
Dr. Smith's ECG Blog
JANUARY 6, 2024
Here, I do not see OMI (although the ECG is falsely STEMI positive with just over 1 mm STE in V1 and about 2.5 In the days before I learned to look for OMI, back when I was counting ST elevation boxes, I used to save ischemia for last.) I interpret tracings systematically in "real time" ( including my assessment for acute ischemia ).
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