Dr. Smith's ECG Blog
JULY 3, 2018
Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve Smith Case A 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain similar to his prior MI, but worse. Remember, pericarditis is the thing you say and write down when youre actively trying to miss an OMI.
Dr. Smith's ECG Blog
MAY 29, 2024
His disease included 70% prox LAD, 80% distal LAD, 10% in-stent stenosis in the distal LCX, 70% OM1, 70% OM2, and 60% prox RCA. Triage ECG: It was interpreted as lateral STEMI, and he was sent to the cath lab, where the angiogram showed unchanged CAD from known prior, with no acute culprit. Three troponins were undetectable.
Dr. Smith's ECG Blog
AUGUST 6, 2024
These latter findings are typical of pericarditis, but pericarditis never has reciprocal ST depression. This led to immediate cath lab activation — which revealed total occlusion of a large 1st diagonal branch that was stented. == Below is the ECG of Patient #3 — recorded from a 35-year old man with sudden, new-onset CP.
Dr. Smith's ECG Blog
MARCH 11, 2016
It was treated with and dual "kissing balloons" and drug eluting stents. Here is the post stent ECG: There is greater than 50% resolution of ST elevation (all but diagnostic of successful reperfusion) and Terminal T-wave inversion (also highly suggestive of successful reperfusion). Myocardial Rupture and Postinfarction Pericarditis.
Dr. Smith's ECG Blog
DECEMBER 11, 2023
Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." Here is the angiogram after stent placement. Is there anything else on the tracing to corroborate inferior OMI? link] Bischof, J.
Dr. Smith's ECG Blog
NOVEMBER 25, 2017
On day 3 of hospitalization she underwent coronary angiography, revealing a 95% lesion in the mid-LAD which was stented. Repeat ECG the next morning: Resolution of findings above, as well as new deep T-wave inversions in V3-V6 and inferior leads, consistent with reperfusion.
Dr. Smith's ECG Blog
JANUARY 28, 2018
Both were stented. In patients with suspicion of acute MI who have any ST elevation, aVL is also a very useful lead to differentiate between pericarditis and MI. Among 49 patients with pericarditis who had inferior ST elevation, zero of 49 had ST depression in aVL (though there are always rare exceptions such as this case ).
Expert insights. Personalized for you.
52 
Let's personalize your content