Remove Ischemia Remove Physiology Remove STEMI
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Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

Dr. Smith's ECG Blog

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.

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Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

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.

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How long would you like to wait for your Occlusion MI to show a STEMI? Sometimes serial ECGs minimizes the delay.

Dr. Smith's ECG Blog

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.

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A 50 year old man with sudden altered mental status and inferior STE. Would you give lytics? Yes, but not because of the ECG!

Dr. Smith's ECG Blog

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.

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What does this ECG show?

Dr. Smith's ECG Blog

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.

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Hyperkalemia

EMS 12-Lead

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.,

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Can you spot the problem with the recording of this 12-lead ECG?

Dr. Smith's ECG Blog

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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