Outcomes, STEMI and Thrombolysis - Cardiovascular Update

Intracoronary thrombolysis in ST-elevation myocardial infarction: a systematic review and meta-analysis

Heart BMJ

JULY 10, 2024

Background Despite restoration of epicardial blood flow in acute ST-elevation myocardial infarction (STEMI), inadequate microcirculatory perfusion is common and portends a poor prognosis. Intracoronary (IC) thrombolytic therapy can reduce microvascular thrombotic burden; however, contemporary studies have produced conflicting outcomes.

Myocardial Infarction

Myocardial Infarction Thrombolysis STEMI Outcomes

AI machines are hot & hungry : Let us learn, teach, and train them in cardiology

Dr. S. Venkatesan MD

NOVEMBER 8, 2024

It is a long read, meant only for those who want to know the hidden intricacies in the concept of “Time window” in STEMI and its important Implication in patient care. [08/11, 08/11, 12:07] Dr S Venkatesan: Is the therapeutic time window for primary PCI and thrombolysis same ? [08/11, How can they be different? [08/11,

Thrombolysis

Thrombolysis Ischemia Hospital Outcomes

Abstract 4141279: Catch me if you flow slow: The temporal filter slow flow fact

Circulation

NOVEMBER 11, 2024

Background:Slow flow phenomenon is impaired coronary flow during percutaneous coronary intervention (PCI) in absence of mechanical obstruction, and it is associated with deteriorated outcome.

STEMI

STEMI Myocardial Infarction Kidney Disease Thrombolysis

The pseudo-superiority of pPCI is exposed one more time … but it will thrive!

Dr. S. Venkatesan MD

SEPTEMBER 1, 2024

“ Since Intravenous lysis looks too simplistic, that do not need expertise, and lacks a commercial trail, it is wrongly depicted as inferior management strategy in STEMI “ Every one of us is equally responsible for this sorry state of affairs. In this context, we need a movement to revive the pre-hospital thrombolysis.

Thrombolysis

Thrombolysis Myocardial Infarction Academic STEMI

An unusual query in Wellen’s syndrome ?

Dr. S. Venkatesan MD

JANUARY 14, 2024

Will evolve into STEMI by prothrombotic trigger of lytic agent ECG will get normalised with clinical stability in some Nothing happens. Majority of Wellens end up as NSTEMI, statistics tells us about 20% of them can be STEMI in incognito mode demanding lysis or emergency PCI. ECG will remain same. How to manage Wellen syndrome?

Anatomy

Anatomy Angina Thrombosis STEMI

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Dr. Smith's ECG Blog

APRIL 22, 2024

Patient still not having chest pain however this is more concerning for OMI/STEMI. Wellens' syndrome is a syndrome of Transient OMI (old terminology would be transient STEMI). A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty.

Chest Pain

Chest Pain Myocardial Infarction Anatomy Angina

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

This has been termed a “STEMI equivalent” and included in STEMI guidelines, suggesting this patient should receive dual anti-platelets, heparin and immediate cath lab activation–or thrombolysis in centres where cath lab is not available. aVR ST segment elevation: acute STEMI or not? J Electrocardiol 2013;46:240-8 2.

Ischemia

Ischemia STEMI Stenosis Chest Pain

Right precordial ST depression in a patient with chest pain

Dr. Smith's ECG Blog

AUGUST 3, 2017

The precordial ST-depression pattern on this ECG (and in this clinical setting) should immediately raise suspicion of Posterior STEMI! Posterior STEMI occurs in approximately 15-20% of acute MI, but the vast majority of the time it is seen in conjunction with inferior (Infero-Posterior) or lateral (Postero-Lateral) STEMI (1).

Chest Pain

Chest Pain Myocardial Infarction STEMI Ischemia

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

Dr. Smith's ECG Blog

APRIL 8, 2022

There is clearly sufficient STE for STEMI criteria in leads V2 and aVL, but lead I has less than 1.0 mm of STE - thus, technically this ECG does not meet STEMI criteria, although it is a quite obvious OMI. This ECG was immediatel y discussed with the on-call cardiologist who said the ECG was "concerning but not a STEMI."

Chest Pain

Chest Pain SCAD STEMI Blog

A Tough ECG, But Learn From It!

Dr. Smith's ECG Blog

JUNE 18, 2013

His ECG was repeated at this point: This shows a well developed anterior STEMI. To not see these findings is very common, and this patient would be given the diagnosis of NonSTEMI, with subsequent development of STEMI. It is not a missed STEMI, but it is a missed coronary occlusion. The peak troponin I was over 100.

STEMI

STEMI Chest Pain Myocardial Infarction Webinar

If you had recorded an ECG during chest pain, what would it have shown?

Dr. Smith's ECG Blog

JUNE 28, 2018

See these posts for Wellens' mimics: Pseudo-Wellens' Syndrome due to Left Ventricular Hypertrophy (LVH) Anterior STEMI? It even meets STEMI criteria: 2.5 A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Am Heart J.

Chest Pain

Chest Pain Myocardial Infarction STEMI Article

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Dr. Smith's ECG Blog

MARCH 11, 2016

cm diameter in the apex The presence of thrombus led the clinicians to state that this was a "late presentation STEMI." It does take some time for thrombus to form, but the EKG and the troponin profile show that this was NOT a late presentation STEMI. Findings: Greater reciprocal ST depression correlated strongly with poor outcome.

Myocardial Infarction

Myocardial Infarction Pericarditis Angina STEMI

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Details cannot be shared here, but suffice it to say that inability to recognize acute occlusive myocardial infarction in the presence of ventricular paced rhythm contributed to a poor outcome. Blinded physicians adjudicated angiogram reports for coronary lesions and thrombolysis in myocardial infarction (TIMI) flow score.

Chest Pain

Chest Pain Myocardial Infarction STEMI Ischemia

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Dr. Smith's ECG Blog

MARCH 9, 2013

Here is the prehospital ECG, with pain: Hyperacute anterolateral STEMI The medics had activated the cath lab and the patient went for angiogram and had a 95% stenotic LAD with TIMI-3 flow. Type B waves are deeper and symmetric. When the patient had chest pain, prior to nitroglycerine, what do you think the ECG showed ? A stent was placed.

Myocardial Infarction

Myocardial Infarction Chest Pain Ischemia Angina

Intracoronary thrombolysis in ST-elevation myocardial infarction: a systematic review and meta-analysis

AI machines are hot & hungry : Let us learn, teach, and train them in cardiology

Abstract 4141279: Catch me if you flow slow: The temporal filter slow flow fact

The pseudo-superiority of pPCI is exposed one more time … but it will thrive!

An unusual query in Wellen’s syndrome ?

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Right precordial ST depression in a patient with chest pain

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

A Tough ECG, But Learn From It!

If you had recorded an ECG during chest pain, what would it have shown?

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

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