Dr. Smith's ECG Blog

DECEMBER 26, 2020

Is this inferor STEMI? Tachycardia and ST Elevation. 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). Long-term outcome is unknown.

Atrial Flutter 52

Atrial Flutter Ischemia STEMI Tachycardia 52

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. 2) Tachycardia to this degree can cause ST segment changes in several ways. Is that an obvious STEMI underneath that rhythm? If I fix the rhythm will the ST changes resolve?

Ischemia 52

Ischemia Atrial Flutter Arrhythmia Tachycardia 52

EMS 12-Lead

MARCH 19, 2023

The shortened PR-interval, specifically, proved to be quite beguiling as it swept crews down a differential diagnosis of intermittent accessory pathway syndrome – insomuch as a “syndrome” of recurrent tachycardia to account for the patient’s symptoms. To which the lead paramedic replied, “Not cardiac; his symptoms are atypical. Is this OMI?

Myocardial Infarction 52

Myocardial Infarction STEMI Coronary Angiogram Coronary Artery Disease 52

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. 2] But there is also Sinus Tachycardia! Then, three minutes later… Crews activated STEMI as she deteriorated into PEA arrest. Physiology. Chapter 4: Cardiovascular Physiology.

ACE Inhibitor 52

ACE Inhibitor Ischemia Physiology 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! Never forget that sinus tachycardia is the scariest arrhythmia. What do you think? mm STE in V2).

Blog 111

Blog Ischemia Tachycardia Physiology 111

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 Cardiogenic Shock STEMI Ischemia 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. Tachycardia is of course, quite common in patients following cardiac arrest. He had multiple cardiac arrests with ROSC regained each time.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52