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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 Aslanger for his brilliant demonstration of how OMI philosophy differs in practice from the previous ( and now outdated ) STEMI paradigm.
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.
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.
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?
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
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.
There’s minimal concave ST elevation in III which does not meet STEMI criteria, so this ECG is "STEMI negative". Use STEMI criteria to identify acute coronary occlusion: the ECG was STEMI negative 2. A repeat ECG was done on way to cath lab: "STEMI negative" again. The cath lab was activated. Take home 1.
The fear comes built in with the diagnosis often amplified by young felllows on call (& often times by senior consultants as well) It may appear real, from a clinical angle, but trust, when we deal with the whole gamut of so-called ACS (other than STEMI), there is indeed a benign face in many of them.
Smith : I recognize this as a STEMI mimic. But vasovagal syncope typically has a prodrome such that further evaluation of today's patient may be needed as an outpatient to better assess for the cause of his sudden syncope. Here is his ECG: There is significant ST Elevation in inferior leads, with reciprocal ST depression in aVL.
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