Ischemia Risk Factors STEMI 
Dr. Smith's ECG Blog
MAY 20, 2024
This EKG is diagnostic of transmural ischemia of the inferior wall. If it is angina, lowering the BP with IV Nitroglycerine may completely alleviate the pain and the (unseen) ECG ischemia. Transmural ischemia (as seen with the OMI findings on ECG) is not very common with demand ischemia, but is possible. Smith SW. .
Dr. Smith's ECG Blog
APRIL 2, 2014
He had some cardiac risk factors including hypertension, on meds, but no previous coronary disease. He had an immediate ED ECG: There is artifact, but the findings appear to be largely gone now The diagnosis is acute MI, but not STEMI. There is about 1 mm of STE in aVR I con sidered but rejected subendocardial ischemia.
Dr. Smith's ECG Blog
NOVEMBER 17, 2014
No risk factors, leads a healthy lifestyle. See my formula for differentiating anterior LV aneurysm (that is to say, persistent ST elevation after old MI) from acute anterior STEMI. Both support acute anterior STEMI. No risk factors, leads healthy lifestyle. BP 112/80, SpO2 100%. PCI is not an option."
Dr. Smith's ECG Blog
AUGUST 15, 2019
He had multiple cardiovascular risk factors and the EM physician strongly suspected ACS. Over the next few hours, four other general cardiologists "signed off on the initial ECG without recognizing STEMI." Learning Points: STEMI criteria misses 25-40% of OMI, like this case for example. mm of the "required" 1.0
Dr. Smith's ECG Blog
JANUARY 1, 2013
Precordial ST depression may be subendocardial ischemia or posterior STEMI. If you thought it might be a posterior STEMI, then you might have ordered a posterior ECG [change leads V4-V6 around to the back (V7-V9)]. I have warned in the past that one must think of other etiologies of ischemia when there is tachycardia.
Dr. Smith's ECG Blog
NOVEMBER 15, 2023
This suggests further severe ischemia. See "Prevention of cardiovascular disease events in those with established disease (secondary prevention) or at very high risk".) This has resulted in an under-representation of STEMI MINOCA patients in the literature. Detailed coronary artery evaluation not performed. Downstream vasospasm?
Dr. Smith's ECG Blog
SEPTEMBER 6, 2011
A 39 yo otherwise healthy man with no risk factors was walking at the mall when he developed chest pressure. Thus, there are some suspicious abnormalities, but no definite signs of ischemia. The difference is significant and highly suggests posterior ischemia. He was diaphoretic. It is very subtle but real.
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