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See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

He visited an outpatient clinic for it and an echocardiogram and exercise stress test was normal. Take home messages: 1- In STEMI/NSTEMI paradigm you search for STE on ECG. Our appreciation to Dr. Aslanger for his brilliant demonstration of how OMI philosophy differs in practice from the previous ( and now outdated ) STEMI paradigm.

STEMI 52
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A man in his 40s with acute chest pain. What do you think?

Dr. Smith's ECG Blog

In the available view of the sinus rhythm, we see normal variant STE which probably meets STEMI criteria in V4 and V5. In other words, the inferior "ST elevation" is due to the abnormal rhythm, and does not signify OMI or STEMI in any way. Hopefully his outpatient EP appointment will understand and correct that. was discovered.

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A Picture of Subendocardial Ischemia

Dr. Smith's ECG Blog

However, there are also Q-waves inferiorly and the inferior T-waves are inverted, suggesting that this is an old MI with persistent ST elevation, or, alternatively, a subacute or partially reperfused, inferior STEMI. This is all but diagnostic of inferior-posterior STEMI. There is ST depression in V4-V6.

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An adolescent with trauma, chest pain, and a wide complex rhythm

Dr. Smith's ECG Blog

He was discharged and schedule for an outpatient echo which has not been done yet. Is there STEMI? : ) Ken Case Outcome: The patient had never had any cardiopulmonary complaints, was otherwise completely healthy. He was admitted overnight and had no complications. More literature on this: 1. What is it? What is the rhythm?

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Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

9 However, because troponin is a clear marker of disease severity and a powerful independent predictor of adverse outcomes, it may be quite useful in the ED disposition decision: if troponin is elevated, then outpatient management should be reconsidered. 12 All STEMI patients had very high cTn typical of STEMI (cTnT > 1.0

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A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

He had multiple cardiac arrests with ROSC regained each time.

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A young woman in her early 20s with syncope

Dr. Smith's ECG Blog

1 week later (about 1 week prior to the tamponade visit) she had a follow up outpatient visit and this ECG was recorded: Appears to show resolving findings. Ultimately, in many cases there is no sure way to distinguish peri/myocarditis from OMI on ECG alone. mm STE depression in aVL.