Dr. Smith's ECG Blog

JANUARY 3, 2024

Interpretation : diagnostic of acute anterior OMI with STE less than STEMI criteria in V1-V4, hyperacute T waves in V2-V4, and suspiciously flat isoelectric ST segments in III and aVF suspicious for reciprocal findings. Now it even meets STEMI criteria, and HATWs continue to inflate. So the cath lab was not activated. Ongoing OMI.

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STEMI Chest Pain Ischemia Outcomes 79

Dr. Smith's ECG Blog

JUNE 8, 2023

STEMI negative : the EMS automated interpretation read, “STEMI negative. According to the STEMI paradigm, the patient doesn’t have an acute coronary occlusion and doesn't need emergent reperfusion, so the paramedics can bring them to the ED for assessment, without involving cardiologists. Inferior infarct, age undetermined.

Chest Pain 60

Chest Pain STEMI Bradycardia Myocardial Infarction 60

Med Page Today

APRIL 9, 2024

(MedPage Today) -- ATLANTA -- Routine use of the Impella CP microaxial flow pump significantly improved survival in patients with infarct-related cardiogenic shock, the randomized DanGer Shock trial showed. In more than 350 patients receiving.

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Cardiogenic Shock STEMI 115

ECG Cases

JANUARY 17, 2023

In this ECG Cases blog we look at 9 patients with possible transient STEMI and discuss pitfalls and pearls in ECG interpretation and management. The post ECG Cases 39 – Transient STEMI Pitfalls and Pearls appeared first on Emergency Medicine Cases.

STEMI 52

STEMI Blog 52

Frontiers in Cardiovascular Medicine

JANUARY 7, 2024

Background Different ST-segment elevation myocardial infarction (STEMI) localizations go along with dissimilarities in the size of the affected myocardium, the causing coronary vessel occlusion, and the right ventricular participation. Results Of the 2,195 patients, 1,118 had an anterior (AWS)- and 1,077 a non-anterior-wall-STEMI (NAWS).

Myocardial Infarction 59

Myocardial Infarction STEMI 59

The British Journal of Cardiology

NOVEMBER 29, 2023

Primary percutaneous coronary intervention (PPCI) remains the gold-standard treatment for ST-elevation myocardial infarction (STEMI). We present the case of a man in his 50s, admitted with cardiac arrest secondary to inferolateral STEMI.

STEMI 52

STEMI Cardiac Arrest Myocardial Infarction Ultrasound 52

ECG Guru

DECEMBER 23, 2023

The Patient: A 60-year-old man at work. He experienced a sudden onset of substernal chest pain, nausea & vomiting, and dizziness. He states the pain is a 5 on 1-10 scale. No cardiac history or current medications. The ECGs: The first ECG , taken at 12:30:05, shows a sinus rhythm with ventricular bigeminy.

STEMI 105

STEMI Chest Pain 105

American College of Cardiology

MARCH 5, 2024

The goal of the RIGHT trial was to determine the efficacy and safety of continuing anticoagulation after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) compared with placebo.

STEMI 40

STEMI Myocardial Infarction Article 40

Journal of Cardiothoracic Surgery

MARCH 29, 2024

Accurately predicting post-discharge mortality risk in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains a complex and critic.

Myocardial Infarction 52

Myocardial Infarction STEMI Research 52

ECG Cases

MAY 10, 2023

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life.

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Chest Pain STEMI Blog Pericarditis 52

Dr. Smith's ECG Blog

APRIL 4, 2023

This patient could have very easily been overlooked, both because the ECG was STEMI negative and because the Q waves were attributed to an “old infarct”. Fortunately, Dr. Cho was not looking for STEMI ECG criteria but for an acute coronary occlusion. OMI or STEMI? As cardiology documented, “possible STEMI.

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Chest Pain STEMI Ischemia Document 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

ECG met STEMI criteria and was labeled STEMI by computer interpretation. J waves can also be induced by Occlusion MI (5), STEMI mimics including takotsubo and myocarditis complicated by ventricular arrhythmias (6, 7), and subarachnoid hemorrhage with VF (8). Take home : Not all STEs are STEMIs or OMIs. What do you think?

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STEMI Bradycardia Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

MAY 31, 2023

Cath lab declined as it is not a STEMI." And now this finding is even formally endorsed as a "STEMI equivalent" in the 2022 ACC guidelines!!! Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mindset. Do NOT give it unless you are committed to the cath lab!! Cath attending is aware. It is a mass delusion.

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STEMI Chest Pain Myocardial Infarction Ischemia 74

Coronary Artery Disease Journal

OCTOBER 31, 2023

Background It is unclear how COVID-19 pandemic affected care and outcomes among patients who are diagnosed with ST-elevation myocardial infarction (STEMI) in the USA. Results There were 1 050 905 hospitalizations with STEMI, and there was an 8.2% reduction in admissions in 2020. to −0.14, P < 0.001) and costs (3.14, 95% CI 2.79

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COVID-19 STEMI Inpatient Hospital 52

ECG Cases

SEPTEMBER 21, 2021

Jesse McLaren explains 'Late STEMI' and how reperfusion strategies should not be based on time of symptom onset. The post ECG Cases 25: ‘Late STEMI’ – How acute is the coronary occlusion? In this ECG Cases blog we look at 10 patients with potentially ischemic symptoms. appeared first on Emergency Medicine Cases.

STEMI 52

STEMI Blog 52

Dr. Smith's ECG Blog

JUNE 19, 2023

This ECG was read as “No STEMI” with no prior available for comparison. It is true this ECG does not meet STEMI criteria (there is 1.0 The Queen of Hearts sees it of course: Still none of these three ECGs meet STEMI criteria. Do you think we discussed this patient's 2-3 hour delay to reperfusion in our quarterly "STEMI meeting"?

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Chest Pain STEMI Cardiogenic Shock Bradycardia 52

Dr. Smith's ECG Blog

DECEMBER 22, 2022

Take home messages: 1- In STEMI/NSTEMI paradigm you search for STE on ECG. If this patient was managed according to the STEMI/NSTEMI paradigm (although he would be a candidate for early invasive treatment), he would probably be taken to the cath lab hours later. Here is the post-intervention angiogram and post-PCI ECG. 2021.21026.

STEMI 52

STEMI Chest Pain Myocardial Infarction Electrocardiogram 52

Nature Reviews - Cardiology

APRIL 22, 2024

Nature Reviews Cardiology, Published online: 23 April 2024; doi:10.1038/s41569-024-01035-9 Data from the DanGer Shock trial demonstrate that implantation of a microaxial flow pump in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock increases the survival rate compared with standard care alone.

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Cardiogenic Shock STEMI Myocardial Infarction 52

ECG Cases

JANUARY 28, 2020

And for STEMI too. The post JJ 16 Heparin for ACS and STEMI appeared first on Emergency Medicine Cases. We’re expected to routinely give heparin for all these NSTEMI and unstable angina patients with any ischemic changes seen on the ECG, right? But should we?

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STEMI Angina 52

Nature Reviews - Cardiology

APRIL 1, 2024

Nature Reviews Cardiology, Published online: 02 April 2024; doi:10.1038/s41569-024-01020-2 In ST-segment elevation myocardial infarction, the role of interventional modification of thrombi in the coronary arteries before stenting is controversial.

STEMI 40

STEMI Myocardial Infarction Embolism Innovation 40

ECG Cases

OCTOBER 22, 2019

Can you identify which were early repolarization and which were anterior STEMI? The post ECG Cases 2: Early Repolarization or Anterior STEMI? In this ECG Cases blog we present ECGs from 7 patients who presented with chest pain and mild anterior ST elevation. appeared first on Emergency Medicine Cases.

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STEMI Chest Pain Blog 52

ECG Cases

MARCH 10, 2020

10 patients presented with the "STEMI-equivalent" ST elevation in aVR with diffuse ST depression. The post ECG cases 7: ST elevation in aVR, STEMI-equivalent? Which had acute coronary occlusion? Jesse McLaren guides us through the differential diagnosis of ST elevation in aVR with diffuse ST depression in this ECG Cases blog.

STEMI 52

STEMI Blog 52

Dr. Smith's ECG Blog

NOVEMBER 27, 2023

The biggest problem with STEMI criteria are false negatives – because this costs patient’s myocardium, with greater mortality and morbidity. For this reason, ECGs need first to be interpreted in isolation, and then applied to the patient. Could this false positive cath lab activation been prevented?

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Chest Pain STEMI Ischemia Anatomy 80

Dr. Smith's ECG Blog

JULY 31, 2020

Their OMI Manifesto details how use of standard STEMI criteria results in an unacceptable level of inaccuracy, in which an estimated 25-30% of acute coronary occlusions are missed! The article by Aslanger, Smith et al that is featured above in today’s post has just been published.

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STEMI Article Chest Pain Blog 52

Med Page Today

MARCH 29, 2024

(MedPage Today) -- Operators safely shaved a few minutes off heart attack reperfusion times by taking patients straight to culprit lesion percutaneous coronary intervention (PCI) when they arrived at the catheterization lab, according to a small.

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STEMI Heart Attack Heart attacks 52

Dr. S. Venkatesan MD

NOVEMBER 25, 2023

” R outine nasal Oxygen has little use in the management of STEMI. It is tough to consider oxygen as a “powerful and magical drug”, because it is freely available everywhere.” In fact, it can be harmful as it causes vasoconstriction.

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STEMI Download Myocardial Infarction Document 40

ECG Cases

DECEMBER 16, 2019

The post ECG Cases 4: Lateral STEMI or Occlusion MI? In this ECG Cases blog we look at seven patients with potentially ischemic symptoms and subtle ECG changes in the lateral leads. Which had acute coronary occlusion? Introducing the concept of Occlusion MI - a paradigm shift in ECG diagnosis of MI.

STEMI 52

STEMI Blog 52

Dr. Smith's ECG Blog

APRIL 18, 2024

I sent this to the Queen of Hearts So the ECG is both STEMI negative and has no subtle diagnostic signs of occlusion. Non-STEMI guidelines call for “urgent/immediate invasive strategy is indicated in patients with NSTE-ACS who have refractory angina or hemodynamic or electrical instability,” regardless of ECG findings.[1]

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STEMI Chest Pain Myocardial Infarction Stents 108

ECG Cases

MAY 7, 2019

The post EM Quick Hits 4 Acetaminophen Overdose & Warfarin Interaction, Dental Infections, MTP RABT Score, Statins for STEMI, Cricothyrotomy Tips appeared first on Emergency Medicine Cases.

STEMI 52

STEMI Angina 52

ECG Cases

FEBRUARY 13, 2024

The post ECG Cases 48 – ECG Interpretation in Cardiac Arrest appeared first on Emergency Medicine Cases.

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Cardiac Arrest STEMI Blog 107

DAIC

APRIL 6, 2024

The Minneapolis Heart Institute Foundation (MHIF) is presenting leading research focused on trends in ST-elevation myocardial infarction (STEMI), the most severe form of a heart attack, at the American College of Cardiology’s Annual Scientific Session (ACC.24), 24), being held April 6-8 in Atltanta, GA.

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Heart Attack Heart attacks Risk Factors Research 52

Dr. Smith's ECG Blog

FEBRUARY 9, 2024

Posterior leads are unnecessary if anterior leads are diagnostic According to the STEMI paradigm an ECG has to have ST elevation to diagnose acute coronary occlusion, and if there’s no ST elevation on anterior leads you can look for it on posterior leads. Do you need posterior leads? If so, how will they change management?

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Chest Pain STEMI Atrial Flutter Ischemia 103

The American Journal of Cardiology

MARCH 21, 2024

Publication date: Available online 21 March 2024 Source: The American Journal of Cardiology Author(s): Dániel Tornyos, Réka Lukács, András Jánosi, András Komócsi

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STEMI 52

Dr. Smith's ECG Blog

MARCH 31, 2024

The interventional cardiologist then canceled the activation and returned the patient to the ED without doing an angiogram ("Not a STEMI"). I advised that perhaps posterior leads would help to persuade the interventionalist, since the 2022 ACC recommendations include posterior STEMI as a formal STEMI equivalent, but only officially by 0.5

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Chest Pain STEMI Myocardial Infarction Ischemia 83

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 59

Myocardial Infarction SCAD STEMI Thrombolysis 59

Dr. Smith's ECG Blog

AUGUST 15, 2019

Over the next few hours, four other general cardiologists "signed off on the initial ECG without recognizing STEMI." Learning Points: STEMI criteria misses 25-40% of OMI, like this case for example. A millimeter definition of acute STEMI should not be needed to justify the need for prompt cardiac catheterization.

STEMI 52

STEMI Chest Pain Risk Factors Anatomy 52

Dr. Smith's ECG Blog

APRIL 6, 2024

In fact, it read: ** **ACUTE MI / STEMI ** ** The physicians caring for the patient activated the cath lab for "STEMI". But the conventional algorithm diagnosed STEMI, and an emergency physician activated the cath team based on this ECG. To an experienced interpreter, it is clearly not due to OMI.

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Chest Pain STEMI Hospital 94