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ECG Cases 50 – STEMI: A Failed Paradigm, Enter Occlusion MI

ECG Cases

Jesse McLaren illustrates the paradigm shift from STEMI to Occlusion MI (OMI) through 9 cases, and drives home the points that if there is STEMI criteria, consider false positives (eg. secondary and proportional to LVH or BER); if there is no STEMI criteria, consider false negatives and look for other signs of occlusion (eg.

STEMI 111
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Prehospital Pulse-Dose Glucocorticoid in STEMI

JAMA Cardiology

This randomized clinical trial investigates if prehospital pulse-dose glucocorticoid treatment has a cardioprotective effect in patients with ST-segment elevation myocardial infarction (STEMI).

STEMI 81
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Complete Revascularization in Older Patients With STEMI

American College of Cardiology

What are long-term clinical benefits of complete versus culprit-only revascularization among ST-segment elevation myocardial infarction (STEMI) patients aged ≥75 years?

STEMI 56
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ECG Blog #426 — Are STEMI Criteria Met?

Ken Grauer, MD

ECG Blog #193 — Reviews the basics for predicting the " culprit " artery ( as well as reviewing why the term "STEMI" — should be replaced by "OMI" = O cclusion-based MI ). . = R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation.

Blog 156
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Acute chest pain, right bundle branch block, no STEMI criteria, and negative initial troponin.

Dr. Smith's ECG Blog

The paramedic called the EM physician ahead of arrival and discussed the case and ECGs, and both agreed upon activating "Code STEMI" (even though of course it is not STEMI by definition), so that the acute LAD occlusion could be treated as fast as possible. So the cath lab was activated. Long term outcome is unavailable.

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Microvascular Injury Patterns After STEMI

American College of Cardiology

What is the prognostic significance of various microvascular injury (MVI) patterns after ST-segment elevation myocardial infarction (STEMI)?

STEMI 73
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60 year old with chest pain, STEMI negative. What should the discharge diagnosis be?

Dr. Smith's ECG Blog

So while there’s no diagnostic STEMI criteria, there are multiple ischemic abnormalities in 11/12 leads involving QRS, ST and T waves, which are diagnostic of a proximal LAD occlusion. First trop was 7,000ng/L (normal 25% of ‘Non-STEMI’ patients with delayed angiography have the exact same pathology of acute coronary occlusion.