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

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

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 110

Blog Ischemia Tachycardia STEMI 110

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. There is sinus tachycardia at 100-105/minute. Admitted to the hospital service for further evaluation and management."

Chest Pain 52

Chest Pain Physiology Blog Stents 52

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

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 One looks for sinus tachycardia and diffuse low voltage but many conditions produce these nonspecific findings.

Pericarditis 40

Pericarditis Hospital Ultrasound Blood Pressure 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. 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