Dr. Smith's ECG Blog

OCTOBER 30, 2023

A 60 yo with 2 previous inferior (RCA) STEMIs, stented, called 911 for one hour of chest pain. Here is his most recent previous ECG: This was recorded after intervention for inferior STEMI (with massive ST Elevation, see below), and shows inferior Q-waves with T-wave inversion typical of completed inferior OMI. ng/mL (quite large).

STEMI 126

STEMI Heart Failure Stents Stent 126

Ken Grauer, MD

MAY 17, 2025

Unfortunately, this was not done because the cardiology team felt "STEMI criteria were not met". See the ADDENDUM below for more on the concept acute OMI ( acute MI due to acute coronary O cclusion ) vs the outdated STEMI paradigm. Cardiology still did not want to perform cardiac cath. . =

Blog 161

Blog STEMI Angina Ischemia 161

Dr. Smith's ECG Blog

DECEMBER 5, 2023

Beyond STEMI: Diagnosing Acute Coronary Occlusion on the ECG. The Queen of Hearts AI app can do it for you. With explainability too.

STEMI 138

STEMI Webinar 138

Open Heart

JANUARY 28, 2025

Introduction ST-elevation myocardial infarction (STEMI) is one of the most prevalent presentations in young patients. Methods A retrospective, multicentre cohort study was carried out in 6799 patients diagnosed with STEMI. to 1.54) (p<0.042).

Myocardial Infarction 95

Myocardial Infarction STEMI Risk Factors Hospital 95

Frontiers in Cardiovascular Medicine

DECEMBER 18, 2024

BackgroundAcute myocardial infarction (AMI), particularly ST-segment elevation myocardial infarction (STEMI), significantly impacts global health, exacerbated by risk factors such as diabetes mellitus (DM). This study highlights the importance of comprehensive FBG monitoring and management to improve outcomes for STEMI patients.

STEMI 52

STEMI Myocardial Infarction Risk Factors Diabetes 52

JAMA Cardiology

AUGUST 29, 2024

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 92

STEMI Myocardial Infarction 92

ECG Cases

APRIL 11, 2023

How can we use the awareness of complications to identify false positive STEMI and Occlusion MI that doesn’t meet classic STEMI criteria, and consider specific treatment? The post ECG Cases 41 – STEMI, Occlusion MI Complications appeared first on Emergency Medicine Cases.

STEMI 87

STEMI 87

Dr. Smith's ECG Blog

DECEMBER 16, 2024

She had this ECG recorded: Obvious massive anterior STEMI She was quickly brought to the critical care area and the cath lab was activated. Here is the ECG at 25 minutes: Terrible LAD STEMI (+) OMI So a CT scan was done which of course showed a normal aorta. This time the Queen of Hearts interpreted: No STEMI or Equivalent.

Chest Pain 106

Chest Pain STEMI Aortic Ultrasound 106

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.

STEMI 108

STEMI Chest Pain Ischemia Outcomes 108

Dr. Smith's ECG Blog

MARCH 27, 2025

Theres ST elevation in V3-4 which meets STEMI criteria, which could be present in either early repolarization, pericarditis or injury. Lets see what happens in the current STEMI paradigm. Emergency physician: STEMI neg but with elevated troponin = Non-STEMI The first ECG was signed off. What do you think?

STEMI 85

STEMI Chest Pain Pericarditis Ischemia 85

Dr. Smith's ECG Blog

JUNE 17, 2025

His first ECG is shown: ECG 1 Obvious STEMI (+) OMI. Because of the obvious presentation and STEMI (+) ECG, the patient was immediately taken to cath lab. There is inferior STEMI. 50-something with STEMI and hypotension: What is the infarct artery? He was brought in by EMS. What would you guess is the culprit?

STEMI 110

STEMI Stents Stent Chest Pain 110

American College of Cardiology

MAY 23, 2024

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

STEMI 73

STEMI Myocardial Infarction Article 73

Dr. Smith's ECG Blog

JULY 7, 2024

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.

Chest Pain 69

Chest Pain STEMI Blog Arrhythmia 69

American College of Cardiology

NOVEMBER 7, 2024

What is the impact of complete revascularization versus culprit-only revascularization on outcomes in older patients with ST-segment elevation myocardial infarction (STEMI) and non–ST-segment elevation myocardial infarction (NSTEMI)?

STEMI 67

STEMI Myocardial Infarction Outcomes Article 67

Dr. Smith's ECG Blog

JANUARY 28, 2025

His first EKG is shown below, with a lead II rhythm strip: EKG 1, 1645 A provisder who is looking for STEMI would not see much in this EKG. It is possible that the T waves in this EKG are of an intermediate morphology between full-blown STEMI and inferior reperfusion. This is the classic morphology of hyperacute T waves.

Chest Pain 109

Chest Pain STEMI Hospital Blood Pressure 109

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.

STEMI 96

STEMI Chest Pain Myocardial Infarction Ischemia 96

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.

Cardiogenic Shock 115

Cardiogenic Shock STEMI 115

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 103

STEMI Chest Pain 103

Dr. Smith's ECG Blog

JANUARY 31, 2025

This ECG pattern is my favorite example of how the STEMI criteria are fundamentally flawed. We have a series of 20 TIMI-0 LAD Occlusions that do meet STEMI criteria. However, many patients with de Winter ECG pattern have TIMI 0 at angiography and the ECG pattern does not necessarily progress to STEMI. 17 have HATW. Under Review.

STEMI 118

STEMI Chest Pain Myocardial Infarction Ischemia 118

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?

Chest Pain 113

Chest Pain STEMI Ischemia Anatomy 113

ECG Cases

JUNE 18, 2024

To support EM Cases, please consider a donation here: [link] The post EM Quick Hits 57 – HIV Diagnosis, Failed Paradigm of STEMI Criteria, Poisoned Patient Airway Management, Spontaneous Bacterial Peritonitis, DIY Investments appeared first on Emergency Medicine Cases.

STEMI 73

STEMI 73

Frontiers in Cardiovascular Medicine

JUNE 13, 2025

This research focused on assessing the ability of the fibrosis-4 (FIB-4) index to predict LVA formation in individuals with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).MethodsWe

Myocardial Infarction 52

Myocardial Infarction Aneurysm STEMI Laboratory 52

Dr. Smith's ECG Blog

JULY 9, 2024

Despite anticipation by many that the initial post-resuscitation ECG will show an obvious acute infarction — this expected "STEMI picture" is often not seen.

Defibrillator 119

Defibrillator STEMI Cardiac Arrest Cardiogenic Shock 119

American College of Cardiology

MAY 28, 2025

Use of complete revascularization (CR) and physiology-guided procedures has increased over time in patients with STEMI and multivessel disease (MVD), with half of patients in 2021 undergoing CR vs. incomplete revascularization (IR), and physiology-based guidance was used in 14%.

Physiology 56

Physiology STEMI Article 56

Frontiers in Cardiovascular Medicine

MARCH 30, 2025

This narrative review aims to evaluate strategies for reducing door-to-balloon (D2B) time in ST-elevation myocardial infarction (STEMI) patients, focusing on pre-hospital, in-hospital, and technological innovations, as well as addressing challenges to ensure sustainability.

Myocardial Infarction 52

Myocardial Infarction STEMI Innovation Technology 52

American College of Cardiology

SEPTEMBER 18, 2024

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

STEMI 54

STEMI Myocardial Infarction Article 54

American College of Cardiology

JUNE 21, 2024

What is the safety and effectiveness of P2Y12 inhibitor pretreatment in patients transferred for primary percutaneous coronary intervention (PPCI) within a regional ST-segment elevation myocardial infarction (STEMI) network?

STEMI 56

STEMI Myocardial Infarction Article 56

Frontiers in Cardiovascular Medicine

FEBRUARY 11, 2025

BackgroundAlthough reperfusion therapy has led to improvements in the acute phase of ST-segment elevation myocardial infarction (STEMI), the incidence of major adverse cardiovascular events (MACE) following STEMI has not significantly decreased. The primary outcome was MACE one-year post-STEMI.

Myocardial Infarction 52

Myocardial Infarction STEMI Obesity BMI 52

Frontiers in Cardiovascular Medicine

APRIL 23, 2025

The lymphocyte to C-reactive protein ratio (LCR) has been established as be a reliable inflammation marker and is associated with the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). ConclusionLower LCR is independently associated with the risk of LVT in patients with STEMI after pPCI.

Myocardial Infarction 52

Myocardial Infarction STEMI Hospital Research 52

Heart BMJ

OCTOBER 10, 2024

Introduction ST-segment elevation myocardial infarction (STEMI) diagnosis is based on a clinical presentation and ST-segment elevation (STE) in at least two consecutive leads. 1 This paradox stems from the incorporation bias and feedback sanction bias detailed in subsequent paragraphs.

STEMI 52

STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

APRIL 8, 2025

Replace STEMI/NSTEMI with OMI/NOMI and AI in the ECG Diagnosis of OMI If you want to find it in the future, you can always find it at the banner above: I gave this Grand Rounds to UC Riverside a couple weeks ago. It is my most up to date lecture on OMI NOMI and Use of AI, especially the Queen of Hearts, in the Diagnosis of Occlusion MI.

STEMI 65

STEMI 65

American College of Cardiology

OCTOBER 9, 2024

What are the outcomes of bivalirudin vs. heparin anticoagulation during percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI)?

STEMI 49

STEMI Myocardial Infarction Outcomes Article 49

ECG Cases

FEBRUARY 13, 2024

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

Cardiac Arrest 126

Cardiac Arrest STEMI Blog 126

Ken Grauer, MD

FEBRUARY 1, 2025

When interpreting ECGs such as the initial tracing in today's case We need to remember that we are not trying to "rule in" an acute STEMI. The paradigm of waiting until STEMI criteria are satisfied is outdated and dangerous. What do these Subtle Findings Mean?

Blog 165

Blog STEMI Physiology Ischemia 165

All About Cardiovascular System and Disorders

FEBRUARY 6, 2024

STEMI – Anterior Wall ECG shows ST elevation myocardial infarction of anterior wall. Up sloping elevation of ST segment is seen in leads V1 to V5, with maximum ST elevation in V2, as is characteristic of anterior wall infarction.

STEMI 52

STEMI Myocardial Infarction Aneurysm Electrophysiology 52

American College of Cardiology

APRIL 7, 2024

Implantation of the Impella CP micro-axial flow pump may increase survival at six months among patients with STEMI complicated by cardiogenic shock (CS), according to the results of the DanGer Shock study.

Cardiogenic Shock 56

Cardiogenic Shock STEMI Article 56

Dr. S. Venkatesan MD

MAY 16, 2024

True bifurcation STEMI with static thrombus (Carinal trapping of thrombus ,Coronary Lerish sydrome ) 4. Embolic STEMI with showers of emboli into both LCX and LAD Simultaneous or sequential Anterior and Inferior STEMI 5. Wrap around LAD true Global MI 2. RCA-dependent LAD circulation through collaterals 3.

STEMI 52

STEMI Pericarditis Embolism Circulation 52