The New England Journal of Medicine

APRIL 7, 2024

Current international clinical practice guidelines recommend complete revascularization for patients with ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease1 on the basis of evidence from randomized, controlled trials.2

Physiology 40

Physiology Myocardial Infarction STEMI 40

Dr. Smith's ECG Blog

JUNE 5, 2023

Here it is: Obvious Inferior Posterior STEMI (+) OMI. Initial troponin was: 3 ng/L We showed that the first troponin in acute STEMI is often negative in at least 27%. Aside on ECG Research: 20% of Definite diagnostic STEMI (Cox et al.) The cath lab was activated prehospital But imagine if the patient had walked in.

Chest Pain 96

Chest Pain STEMI Physiology Stents 96

Dr. Smith's ECG Blog

DECEMBER 20, 2010

SCM may happen from a wide variety of psychological or physiological stresses, including respiratory failure (although in this case a psychological stress led to poor myocardial function and then pulmonary edema, then respiratory failure) and intracranial bleeding. In this case, the ECG never mimicked a STEMI.

Echocardiogram 52

Echocardiogram Cardiomyopathy Ultrasound STEMI 52

Dr. S. Venkatesan MD

DECEMBER 2, 2023

This has important clinical significance , as many successfully lysed STEMI patient might have minimal segments of dissection/deep plaque fissures. , Spontaneous coronary dissection vs Iatrogenic dissection SCAD is a rare , different entity , enjoys a popular space in the patho-physiology of CAD.

SCAD 52

SCAD Plaque Angina STEMI 52

Circulation

NOVEMBER 11, 2024

Background:5-Hydroxytryptophan (5-HTP) is a natural amino acid and precursor to serotonin, which is essential for various physiological functions. Conclusion:Higher 5-HTP levels are independently associated with a reduced risk of MACE in patients after STEMI. years, 53 women) followed for up to 15 years.

Myocardial Infarction 40

Myocardial Infarction Coronary Artery Bypass Graft STEMI Angina 40

Ken Grauer, MD

APRIL 18, 2023

In contrast — it is EASY to overlook L A- L L reversal — because the ECG picture seen with this type of lead reversal does not immediately stand out as physiologically “off”. P utting I t A ll T ogether : After correcting for LA-LL lead reversal — ECG # 1a shows sinus rhythm — LVH — and an acute infero-postero STEMI with acute RV involvement.

Blog 78

Blog STEMI Chest Pain Physiology 78

Dr. Smith's ECG Blog

DECEMBER 26, 2020

Is this inferor STEMI? Atrial Flutter with Inferior STEMI? Inferolateral ST elevation, vomiting, and elevated troponin The treating team did not identify the flutter waves and they became worried about possible "STEMI" (despite the unusual clinical scenario). The EM provider asked if the cardiologist thought it was a "STEMI."

Atrial Flutter 52

Atrial Flutter Ischemia STEMI Tachycardia 52

Dr. Smith's ECG Blog

MARCH 15, 2021

The computer read Anterior STEMI along with RBBB. I would activate the cath lab based on this and the clinical presentation, but I do NOT see any evidence of anterior STEMI The patient arrived in the ED and had this ECG: The T-waves are now less hyperacute, but ST Elevation remains. Here is his prehospital ECG: What do you think?

Chest Pain 40

Chest Pain Ultrasound Pericarditis STEMI 40

Dr. Smith's ECG Blog

AUGUST 4, 2024

QOH versions 1 and 2 both say Not OMI, with high confidence, without any clinical context, despite the abnormal STE meeting STEMI criteria. Serial echo monitoring showed increasing pericardial pressures without overt tamponade physiology. Of note, there is arguably terminal QRS distortion in V4-V6. Pericarditis maybe."

Pericarditis 117

Pericarditis Chest Pain Blog Aortic 117

Circulation

NOVEMBER 11, 2024

Frailty is a syndrome of physiological decline, characterized by marked vulnerability to adverse health outcomes. Over 600,000 percutaneous coronary interventions (PCI) are performed each year for IHD. Frailty and CVD are often interrelated, affecting disease and treatment outcomes. Frailty is prevalent in adults with IHD requiring PCI.

Heart Disease 40

Heart Disease Hospital Inpatient Outcomes 40

Dr. Smith's ECG Blog

JANUARY 5, 2024

And, the drug does provide physiologic benefits for a patient with an acute cardiac event ( ie, it helps to relieve anxiety as well as pain — which may decrease activation of autonomic nervous system activity — often resulting in reduced heart rate, blood pressure, venous return and myocardial oxygen demand — Murphy et al: StatPearls, 2023 ).

Angina 121

Angina Plaque Document Stents 121

EMS 12-Lead

MARCH 19, 2023

Another factor to be considered, according to Chou’s textbook, is that many patients have dual AVN physiology and conduction is preferential down the fast pathway. It doesn’t meet any conventional STEMI criteria, but there is patently obvious increased area under the curve. The shortened PR-interval is probably an accessory pathway.”

Myocardial Infarction 52

Myocardial Infarction STEMI Coronary Angiogram Coronary Artery Disease 52

EMS 12-Lead

APRIL 14, 2022

There is mixed overlap of ST-segment elevation (STE), ST-segment depression (STD), Hyperacute T waves (HATW), and deWinter pattern (which the ACC regards as a STEMI-equivalent but is better suited under the blanket of OMI). Physiology. Chapter 4: Cardiovascular Physiology. 2] Costanzo, L. Elsevier: Philadelphia, PA. [3]

ACE Inhibitor 52

ACE Inhibitor Physiology Chest Pain Academic 52

Dr. Smith's ECG Blog

OCTOBER 7, 2019

There is an obvious inferior STEMI, but what else? Besides the obvious inferior STEMI, there is across the precordial leads also, especially in V1. This STE is diagnostic of Right Ventricular STEMI (RV MI). In fact, the STE is widespread, mimicking an anterior STEMI. EKG is pictured below: What do you think?

Bradycardia 40

Bradycardia STEMI Cardiogenic Shock Ischemia 40

EMS 12-Lead

MAY 8, 2022

The attending crews were concerned for SVT with corresponding ischemic hyperacute T waves (HATW) and subsequently activated STEMI pre-hospital. Then, three minutes later… Crews activated STEMI as she deteriorated into PEA arrest. Physiology. Chapter 4: Cardiovascular Physiology. 3] Costanzo, L. 4] Parham, W.

ACE Inhibitor 52

ACE Inhibitor Ischemia STEMI Physiology 52

Dr. Smith's ECG Blog

APRIL 3, 2019

Not quite a STEMI, but same effect.) There is ST elevation in V2-V4 that does not quite meet "STEMI criteria." That is a reasonable thought, but we have shown that if there is one lead of V1-V4 with a T/QRS ratio greater than 0.36, then it is STEMI, not LV aneurysm. Is this a transient STEMI? Is it normal ST elevation?

STEMI 40

STEMI Chest Pain Ischemia Aneurysm 40

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

The axiom of "type 1 (ACS, plaque rupture) STEMIs are not tachycardic unless they are in cardiogenic shock" is not applicable outside of sinus rhythm. This case represents the same physiologic event as OMI in terms of the result on the myocardium, therefore with identical ECG features, however there may not be ACS!

Ischemia 52

Ischemia Atrial Flutter Arrhythmia Tachycardia 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2023

Diagnosis: Acute non-ST segment elevation MI (Non-STEMI, or NSTEMI) Second troponin returned at around 0200: 15,894 ng/L 0245 (unclear if ongoing pain or not) Inferoposterior (and lateral V5-6) reperfusion findings. Admitted to the hospital service for further evaluation and management."

Chest Pain 52

Chest Pain Physiology Blog Stents 52

Dr. Smith's ECG Blog

OCTOBER 13, 2022

But it doesn’t meet STEMI criteria, and was not identified by the computer or the over-reading cardiologist. Still no WPW pattern, and more obvious inferoposterior OMI, but still STEMI negative. The emergency physician wasn’t sure what to make of the changes from one ECG to the next but was concerned about ACS. What do you think?

Chest Pain 52

Chest Pain Myocardial Infarction Ischemia STEMI 52

Dr. Smith's ECG Blog

JANUARY 6, 2024

Here, I do not see OMI (although the ECG is falsely STEMI positive with just over 1 mm STE in V1 and about 2.5 The atrial rate is around 120 beats per minute, which indicates high adrenergic state and physiologic distress! What do you think? mm STE in V2). The Queen of Hearts also sees no OMI with high confidence.

Blog 111

Blog Ischemia Tachycardia STEMI 111

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. 2 The astute paramedic recognized this possibility and announced a CODE STEMI. Any alteration in physiology can change "compensated" AS to "decompensated" AS. What do you see?

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

APRIL 20, 2018

Patients like her are the reason we are advocating for a change in the ACS paradigm from STEMI to OMI. For some reason (with debatable physiology), coronary occlusion often causes decrease in the high voltage of LVH on the EKG. I took part in her ICU care and she was extubated and stable to transfer to a stepdown unit after a few days.

Chest Pain 40

Chest Pain Ultrasound Risk Factors STEMI 40

Dr. Smith's ECG Blog

DECEMBER 27, 2018

But lead V2 has a worrisome amount of ST elevation, and in a chest pain patient, I would be worried about STEMI. My subjective interpretation, and that of Pierre's, is of LVH with secondary repolarization abnormalities, including pseudoSTEMI ST elevation in V1-V3. The Ratios of STE to S-wave: V1: 2.5/16

Chest Pain 40

Chest Pain Hypertension STEMI Heart Disease 40

Dr. Smith's ECG Blog

OCTOBER 10, 2022

The ECG accurately reflects the physiologic state of the underlying myocardium, but there is always more than one possible etiology of that physiologic state. He had multiple cardiac arrests with ROSC regained each time.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

JULY 12, 2020

This paper by Bischof and Smith compared inferior MI to pericarditis and found that of 154 patients with inferior STEMI, 17% of whom had less than 1 mm of STE in any inferior lead, all 154 had at least 0.25 Maybe an increase in pericardial fluid could have been observed and helped to prevent her acute decompensation one week later.

Pericarditis 40

Pericarditis Hospital Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

DECEMBER 18, 2022

In addition — Morphology of the QRS complex and ST-T wave of lead V3 does not make physiologic sense in ECG #1 , considering the relative size and shape of the QRST complex in neighboring leads V2 and V4.

Myocardial Infarction 40

Myocardial Infarction Chest Pain Blog Echocardiogram 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. How does the Queen of Hearts do?

Chest Pain 115

Chest Pain Myocardial Infarction Pacemaker STEMI 115

Ken Grauer, MD

FEBRUARY 1, 2025

When interpreting ECGs such as the initial tracing in today's case We need to remember that we are not trying to "rule in" an acute STEMI. Physiologically this may occur as a result of very brief coronary occlusion, followed so soon after by spontaneous reperfusion. What do these Subtle Findings Mean?

Blog 165

Blog STEMI Physiology Ischemia 165

Dr. Smith's ECG Blog

JANUARY 28, 2025

His first EKG is shown below, with a lead II rhythm strip: EKG 1, 1645 A provisder who is looking for STEMI would not see much in this EKG. It is possible that the T waves in this EKG are of an intermediate morphology between full-blown STEMI and inferior reperfusion. This is the classic morphology of hyperacute T waves.

Chest Pain 105

Chest Pain STEMI Hospital Blood Pressure 105

Dr. Smith's ECG Blog

MARCH 8, 2025

Given the immediate physiologic chain reaction of intense autonomic dysfunction that followed on learning of her husband's death ( and which ultimately led to this patients demise ) I have to wonder WHEN ( and How? ) With regard to the Physiologic Chain Reaction As per Dr. Frick We do not have all the answers.

Cardiomyopathy 75

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75