STEMI and Thrombolysis - Cardiovascular Update

Intracoronary thrombolysis in ST-elevation myocardial infarction: a systematic review and meta-analysis

Heart BMJ

JULY 10, 2024

Background Despite restoration of epicardial blood flow in acute ST-elevation myocardial infarction (STEMI), inadequate microcirculatory perfusion is common and portends a poor prognosis. IC thrombolysis was associated with a significantly lower incidence of MACE (RR=0.65, 95% CI 0.51 to 2.67; I 2 =25%; p<0.0001).

Myocardial Infarction

Myocardial Infarction Thrombolysis STEMI Outcomes

Differences in left ventricular myocardial function and infarct size in female patients with ST elevation myocardial infarction and spontaneous coronary artery dissection

Frontiers in Cardiovascular Medicine

JANUARY 7, 2024

Introduction Differences in pathophysiology, clinical presentation, and natural course of ST-elevation myocardial infarction in female patients due to either spontaneous dissection (SCAD-STEMI) or atherothrombotic occlusion (type 1 STEMI) have been discussed. vs. 1.8 ± 5.1%, p = 0.002). vs. 1.8 ± 5.1%, p = 0.002).

Myocardial Infarction

Myocardial Infarction SCAD STEMI Thrombolysis

Why every cardiologist is guilty, in a fundamental Issue in STEMI management ?

Dr. S. Venkatesan MD

OCTOBER 31, 2024

Time window s for intervention for thrombolysis in STEMI starts from onset of chest pain, but when it comes to primary PCI, a different time window takes the center stage pushing the former to the background. How can we have uniform std of 90-120 minutes D2B in all STEMI cases ? Why is this disparity?

STEMI

STEMI Chest Pain Anatomy Thrombolysis

The pseudo-superiority of pPCI is exposed one more time … but it will thrive!

Dr. S. Venkatesan MD

SEPTEMBER 1, 2024

“ Since Intravenous lysis looks too simplistic, that do not need expertise, and lacks a commercial trail, it is wrongly depicted as inferior management strategy in STEMI “ Every one of us is equally responsible for this sorry state of affairs. In this context, we need a movement to revive the pre-hospital thrombolysis.

Thrombolysis

Thrombolysis Myocardial Infarction Academic STEMI

Age-associated declined function of endothelial progenitor cells and its correlation with plasma IL-18 or IL-23 concentrations in patients with ST-segment elevation myocardial infarction

Frontiers in Cardiovascular Medicine

MAY 24, 2024

BackgroundST-segment elevation myocardial infarction (STEMI) persists to be prevalent in the elderly with a dismal prognosis. Nevertheless, the influence of aging on the functionality of EPCs in STEMI is not fully understood.MethodThis study enrolled 20 younger STEMI patients and 21 older STEMI patients.

Myocardial Infarction

Myocardial Infarction STEMI Thrombolysis

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Dr. Smith's ECG Blog

APRIL 22, 2024

Patient still not having chest pain however this is more concerning for OMI/STEMI. Wellens' syndrome is a syndrome of Transient OMI (old terminology would be transient STEMI). A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty.

Chest Pain

Chest Pain Myocardial Infarction Anatomy Angina

An unusual query in Wellen’s syndrome ?

Dr. S. Venkatesan MD

JANUARY 14, 2024

Will evolve into STEMI by prothrombotic trigger of lytic agent ECG will get normalised with clinical stability in some Nothing happens. Majority of Wellens end up as NSTEMI, statistics tells us about 20% of them can be STEMI in incognito mode demanding lysis or emergency PCI. ECG will remain same. How to manage Wellen syndrome?

Anatomy

Anatomy Angina Thrombosis STEMI

Right precordial ST depression in a patient with chest pain

Dr. Smith's ECG Blog

AUGUST 3, 2017

The precordial ST-depression pattern on this ECG (and in this clinical setting) should immediately raise suspicion of Posterior STEMI! Posterior STEMI occurs in approximately 15-20% of acute MI, but the vast majority of the time it is seen in conjunction with inferior (Infero-Posterior) or lateral (Postero-Lateral) STEMI (1).

Chest Pain

Chest Pain Myocardial Infarction STEMI Ischemia

A Tough ECG, But Learn From It!

Dr. Smith's ECG Blog

JUNE 18, 2013

His ECG was repeated at this point: This shows a well developed anterior STEMI. To not see these findings is very common, and this patient would be given the diagnosis of NonSTEMI, with subsequent development of STEMI. It is not a missed STEMI, but it is a missed coronary occlusion. The peak troponin I was over 100.

STEMI

STEMI Chest Pain Myocardial Infarction Webinar

Abstract 4141279: Catch me if you flow slow: The temporal filter slow flow fact

Circulation

NOVEMBER 11, 2024

Methods:STEMI patients who underwent coronary revascularization therapy and cardiac magnetic resonance (CMR) at about 4 days and 6 months between 2017 and 2023 were included.

Myocardial Infarction

Myocardial Infarction STEMI Kidney Disease Thrombolysis

Something Winter This Way Comes

EMS 12-Lead

AUGUST 14, 2022

A second 12 Lead ECG was recorded: This is a testament to the dynamic nature of coronary thrombosis and thrombolysis. it has been subsequently deemed a STEMI-equivalent. The patient verbalized spontaneous improvement just before 324mg ASA administration. But the lesion is still active!

STEMI

STEMI Sudden Cardiac Death Thrombosis Thrombolysis

An elderly male with shortness of breath

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

Smith : there is some minimal ST elevation in V2-V6, but does not meet STEMI criteria. Transient STEMI has been studied and many of these patients will re-occlude in the middle of the night. Is it normal STE? The computer thinks so, and the physician thinks that is quite possible. However , there is terminal QRS distortion in lead V3.

Chest Pain

Chest Pain Myocardial Infarction STEMI Critical Care

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

This has been termed a “STEMI equivalent” and included in STEMI guidelines, suggesting this patient should receive dual anti-platelets, heparin and immediate cath lab activation–or thrombolysis in centres where cath lab is not available. aVR ST segment elevation: acute STEMI or not? J Electrocardiol 2013;46:240-8 2.

Ischemia

Ischemia STEMI Stenosis Chest Pain

Does the “Non -IRA” lesion status confuse you often ? Try a blind primary PCI !

Dr. S. Venkatesan MD

APRIL 13, 2024

Permanently deferred PCI is other wise called medical management , is practiced by some inferior cardiologists or GPs who never refer such patients to higher centers after a stand alone thrombolysis) * The FFR, iFR RFR, related stuff What if if we are completely blinded to the status of Non IRA vessel ? What do you mean ?

Thrombosis

Thrombosis Thrombolysis Academic Document

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

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."

Chest Pain

Chest Pain SCAD STEMI Blog

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Dr. Smith's ECG Blog

MARCH 9, 2013

Here is the prehospital ECG, with pain: Hyperacute anterolateral STEMI The medics had activated the cath lab and the patient went for angiogram and had a 95% stenotic LAD with TIMI-3 flow. Type B waves are deeper and symmetric. When the patient had chest pain, prior to nitroglycerine, what do you think the ECG showed ? A stent was placed.

Myocardial Infarction

Myocardial Infarction Chest Pain Ischemia Angina

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Dr. Smith's ECG Blog

MARCH 11, 2016

cm diameter in the apex The presence of thrombus led the clinicians to state that this was a "late presentation STEMI." It does take some time for thrombus to form, but the EKG and the troponin profile show that this was NOT a late presentation STEMI. LV Thrombus , 1.5 0 0 1 95 544 MMRF 4 1 638 14.0 Methods: Vermeer et al.

Myocardial Infarction

Myocardial Infarction Pericarditis Angina STEMI

If you had recorded an ECG during chest pain, what would it have shown?

Dr. Smith's ECG Blog

JUNE 28, 2018

See these posts for Wellens' mimics: Pseudo-Wellens' Syndrome due to Left Ventricular Hypertrophy (LVH) Anterior STEMI? It even meets STEMI criteria: 2.5 A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Am Heart J.

Chest Pain

Chest Pain Myocardial Infarction STEMI Article

A man in his 50s with acute chest pain and LVH

Dr. Smith's ECG Blog

DECEMBER 14, 2022

I am going to code this as an acute STEMI as he had transient ST elevation which started to evolve in the emergency department but I think this is most appropriately termed STEMI." When is it anterior STEMI? No formal echo was done, and EF was normal on ventriculogram during cath, with no obvious wall motion abnormalities.

Chest Pain

Chest Pain STEMI Blog Stenosis

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Smith15, and PERFECT Study Author Group 1 Hennepin County Medical Center, 2 Minneapolis Medical Research Foundation, 3 Background : The Smith-modified Sgarbossa criteria (MSC) are frequently recommended for diagnosing acute coronary occlusion (ACO; STEMI-equivalent) in the setting of ventricular paced rhythm (VPR).

Chest Pain

Chest Pain Myocardial Infarction STEMI Ischemia

Concerning EKG with a Non-obstructive angiogram. What happened?

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The commonest causes of MINOCA include: atherosclerotic causes such as plaque rupture or erosion with spontaneous thrombolysis, and non-atherosclerotic causes such as coronary vasospasm (sometimes called variant angina or Prinzmetal's angina), coronary embolism or thrombosis, possibly microvascular dysfunction.

Plaque

Plaque Angina Blog Stents

AI machines are hot & hungry : Let us learn, teach, and train them in cardiology

Dr. S. Venkatesan MD

NOVEMBER 8, 2024

It is a long read, meant only for those who want to know the hidden intricacies in the concept of “Time window” in STEMI and its important Implication in patient care. [08/11, 08/11, 12:07] Dr S Venkatesan: Is the therapeutic time window for primary PCI and thrombolysis same ? [08/11, How can they be different? [08/11,

Thrombolysis

Thrombolysis Ischemia Hospital Outcomes

Intracoronary thrombolysis in ST-elevation myocardial infarction: a systematic review and meta-analysis

Differences in left ventricular myocardial function and infarct size in female patients with ST elevation myocardial infarction and spontaneous coronary artery dissection

Why every cardiologist is guilty, in a fundamental Issue in STEMI management ?

The pseudo-superiority of pPCI is exposed one more time … but it will thrive!

Age-associated declined function of endothelial progenitor cells and its correlation with plasma IL-18 or IL-23 concentrations in patients with ST-segment elevation myocardial infarction

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

An unusual query in Wellen’s syndrome ?

Right precordial ST depression in a patient with chest pain

A Tough ECG, But Learn From It!

Abstract 4141279: Catch me if you flow slow: The temporal filter slow flow fact

Something Winter This Way Comes

An elderly male with shortness of breath

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Does the “Non -IRA” lesion status confuse you often ? Try a blind primary PCI !

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

If you had recorded an ECG during chest pain, what would it have shown?

A man in his 50s with acute chest pain and LVH

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

Concerning EKG with a Non-obstructive angiogram. What happened?

AI machines are hot & hungry : Let us learn, teach, and train them in cardiology

Stay Connected