Dr. Smith's ECG Blog

AUGUST 9, 2024

Automatic activity refers to enhanced pacemaking function (typically from a non sinus node source), for example atrial tachycardia. The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI. Is there STEMI? The patient continued having chest pain. What is the rhythm? Moffat, M.

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Chest Pain Arrhythmia Myocardial Infarction STEMI 107

Dr. Smith's ECG Blog

MAY 31, 2011

ST segments: There is obvious inferior STEMI, with ST elevation (and Q-waves and T-wave inversion) in II, III, aVF and reciprocal depression in I and aVL. or there is a low atrial pacemaker and 3rd degree block, and sinus brady, and junctional escape). Here is the initial ECG: Rhythm: slow and regular. What is it really?

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Chest Pain Pacemaker STEMI 52

Dr. Smith's ECG Blog

JANUARY 19, 2020

There is STE in III and aVF which does not meet STEMI criteria due to insufficient STE in lead aVF. The interventionalists insisted that the ECGs did not meet STEMI criteria and cancelled the activation, stating that they would consider urgent cath after further stabilization. This is an obvious inferoposterior OMI.

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Bradycardia STEMI AFIB Pacemaker 52

Ken Grauer, MD

JANUARY 20, 2024

The patient may need a pacemaker. CASE F ollow- U p: Providers in today's case recognized the above abnormalities — and promptly referred the patient to a PCI center for cardiac catheterization and potential pacemaker insertion. == L ooking C loser at Today's R hythm: The rhythm in Figure-1 has a number of complexities.

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Blog Bradycardia STEMI Download 95

Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. If there had been — a temporary atrial pacemaker could have been considered as a way of increasing the heart rate to suppress a bradycardia-dependent arrhythmia ("overdrive pacing"). The below ECG was recorded.

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

JANUARY 1, 2024

Again, see Ken's discussion below) Discussion continued The absence of pace spikes suggests this is not a pacemaker/ICD-related rhythm in this patient with an ICD. Are the apparent P-waves (which now we suspect might not be P-waves) actually part of the QRS, in which case the QRS is even wider than it appears? Where does the QRS begin?

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Tachycardia Blog Ischemia Heart Failure 112

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."

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Chest Pain SCAD STEMI Blog 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2023

Later, I found old ECGs: 5 month prior in clinic: V5 and V6 look like OMI 9 months prior in clinic with no chest symptoms: V5 and V6 look like OMI 1 year prior in the ED with chest pain: V5 and V6 sure look like a STEMI For this ECG and chest pain in the ED, the Cath lab activated. But the angiogram was clean. There was no OMI.

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Stroke Strokes Chest Pain Cardiomyopathy 70

Dr. Smith's ECG Blog

JUNE 14, 2017

Is there STEMI? A Patient with Ischemic symptoms and a Biventricular Pacemaker Most physicians, at first glance, get this wrong. What is it? What is the rhythm? And is there new left bundle branch block (LBBB)? Is this Left Bundle Branch Block? Giant R-waves. What are they?

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Chest Pain Congenital Heart Disease Article Congenital 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

The medics recorded the following initial ECG at time 0: The computer read (see below) gives no further comment beyond ventricular pacemaker. And, in cases like the elderly patient with new-onset chest pain presented here — definitive diagnosis of acute STEMI is sometimes deceptively easy. What do you think?

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Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

MAY 19, 2022

Anterior STEMI? This gradual change in P wave morphology as the heart rate varies could be consistent with a wandering atrial pacemaker. T-wave inversions and dynamic ST elevation Tachycardia, hyperthyroid, and ST elevation. What is it? 2 Cases of Resolved Chest Pain with Dynamic Terminal T-wave Inversion Is it Wellens' Syndrome?

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Chest Pain Exercise Pacemaker Coronary Angiogram 52

EMS 12-Lead

JUNE 20, 2022

A prehospital STEMI activation was transmitted to the closest PCI center, and 324mg ASA was administered. The attending crews were concerned for an ACS-equivalent of LAD occlusion and initiated a prehospital STEMI activation to the closest PCI center. It’s important to stress the presence of a normal QRS (i.e.,

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STEMI Stent Stents Myocardial Infarction 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

Using the STEMI paradigm would have resulted in significant delays for this patient, which correspond with the doubled mortality and morbidity of NSTEMI Occlusions seen in over 50,000 subjects in NSTEMI trials. == MY Comment, by K EN G RAUER, MD ( 9/30/2019 ): == Our THANKS to Dr. I never see 2 P waves in a row with the same morphology.

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Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

FEBRUARY 15, 2018

100% occluded RCA with TIMI 0 flow Post drug-eluting stent placement with TIMI 3 flow While in the cath lab, she transiently developed complete heart block and became hypotensive requiring transvenous pacemaker placement and transient pressors. The transvenous pacemaker was removed the following day and pressors were not required again.

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Chest Pain Critical Care Article Pacemaker 52

Dr. Smith's ECG Blog

FEBRUARY 27, 2023

In fact, sometimes the sinus node is working and acting as a pacemaker but no P waves are visible!! See many examples of Pseudo STEMI due to hyperkalemia at these two posts: Acute respiratory distress: Correct interpretation of the initial and serial ECG findings, with aggressive management, might have saved his life.

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Tachycardia Document Blog Bradycardia 52

Dr. Smith's ECG Blog

FEBRUARY 23, 2023

Learning Points: Ectopic atrial rhythm can produce atrial repolarization findings that can be confused for acute ischemia, STEMI, or OMI. The patient was worked up for abdominal pain with unclear diagnosis, and he was able to be discharged.

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Blog Bradycardia Ischemia Exercise 52

Dr. Smith's ECG Blog

JANUARY 16, 2020

Also a h/o LV aneurysm with thrombus, on anticoagulation, as well as a dual chamber pacemaker. Marked acute STEMI changes in no less than 4 lateral leads. She had a history of PCI to the circumflex and also of severe mitral regurgitation, status post bioprosthetic valve replacement. On arrival, the BP was 60/30.

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Aneurysm Heart Disease Stent Stents 40

Dr. Smith's ECG Blog

JULY 19, 2024

It was read by the treating physician and the overreading cardiologist as "Paced, no STEMI." As the troponin T was 1521 ng/L (peak troponin T over 1000 ng/L is typical of STEMI) and still rising, no further troponins were measured. NOTE #2: I always like to look for the presence of an underlying rhythm in pacemaker tracings.

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Chest Pain Myocardial Infarction Pacemaker STEMI 115

Ken Grauer, MD

FEBRUARY 21, 2025

Abnormal ST elevation is also seen in the high-lateral limb leads ( = leads I and aVL ) which together with the abnormal ( and very large ) Q waves and QS complexes in 8/12 leads suggests that the reason for this ventricular rhythm is a recent and/or ongoing extensive antero-lateral STEMI. The above said Today's patient had other ideas.

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Blog STEMI Hospital Pacemaker 127

Dr. Smith's ECG Blog

MARCH 8, 2025

2:34 PM, following right heart catheterization She then went into atrial fibrillation with complete heart block and junctional escape rhythm prompting placement of transvenous pacemaker. There was indication of parasympathetic overdrive ( the acute inferior STEMI with profound bradycardia and junctional escape ).

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Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75