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 65

STEMI 65

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 134

STEMI Webinar 134

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

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 89

STEMI Chest Pain Ischemia Outcomes 89

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 68

Chest Pain STEMI Bradycardia Myocardial Infarction 68

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

American College of Cardiology

JUNE 5, 2024

What is the impact of the administration of cangrelor at reperfusion on myocardial infarct (MI) size and microvascular obstruction (MVO) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI)?

STEMI 43

STEMI Myocardial Infarction Article 43

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

American College of Cardiology

MAY 20, 2024

Microvascular resistance reserve (MRR), as a measure of coronary microvascular dysfunction (CMD), can be a strong predictor of major adverse cardiovascular and cerebrovascular events (MACCE) at 12 months in patients with STEMI.

STEMI 40

STEMI Article 40

Dr. S. Venkatesan MD

MAY 16, 2024

If the thrombus migrates to one of the branches, it might evolve either as LAD STEMI, LCX STEMI, or a combination of both. We have seen a few lucky Left main STEMIs in the cath lab, with some spontaneous canalization. Most such patients do not reach the hospital. Final message De-novo Coronary Leriche syndrome is a real entity.

STEMI 40

STEMI Aortic Hospital 40

American College of Cardiology

MAY 20, 2024

Microvascular resistance reserve (MRR) measured directly after primary PCI was an independent predictor of all-cause mortality or hospitalization for heart failure (HF) in patients with a STEMI over long-term follow-up, according to the results of a pooled analysis.

STEMI 40

STEMI Hospital Heart Failure Article 40

All About Cardiovascular System and Disorders

MAY 26, 2024

Immediate Microvascular Physiology After Mechanical Coronary Reperfusion of STEMI. MRR = (CFR/FFR) × (P a,rest /P a,hyper ) References Michel Zeitouni, Ghilas Rahoual, Gilles Montalescot, and the ACTION study group. J Am Coll Cardiol. 2024 May, 83 (21) 2077–2079. van Leeuwen, Stephen P.

STEMI 52

STEMI Outcomes Coronary Artery Disease Myocardial Infarction 52

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

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

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

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.

Chest Pain 52

Chest Pain STEMI Blog Pericarditis 52

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

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 88

STEMI Chest Pain Myocardial Infarction Ischemia 88

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 110

Defibrillator STEMI Cardiac Arrest Cardiogenic Shock 110

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.

Chest Pain 52

Chest Pain STEMI Ischemia Document 52

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 90

Cardiogenic Shock STEMI 90

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

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?

STEMI 52

STEMI Bradycardia Arrhythmia Cardiac Arrest 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

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

COVID-19 52

COVID-19 STEMI Inpatient Hospital 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"?

Chest Pain 52

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 Echocardiogram 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?

STEMI 52

STEMI Angina 52

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.

STEMI 52

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?

Chest Pain 96

Chest Pain STEMI Ischemia Anatomy 96

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.

STEMI 52

STEMI Article Chest Pain Blog 52

Dr. Smith's ECG Blog

JUNE 7, 2024

Obvious infero-postero-lateral STEMI(+)OMI, regardless of context Now let’s put them in order: what was the sequence? With serial ECGs that are ‘STEMI negative’ the physician could have waited for serial troponin levels or referred the patient as “non-STEMI”. What was the outcome and final diagnosis?

Chest Pain 105

Chest Pain STEMI Outcomes Document 105

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

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.

Cardiogenic Shock 52

Cardiogenic Shock STEMI Myocardial Infarction 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

Dr. Smith's ECG Blog

MAY 27, 2024

The ECG did not meet STEMI criteria, and the final cardiology interpretation was “ST and T wave abnormality, consider anterior ischemia”. There’s only minimal ST elevation in III, which does not meet STEMI criteria of 1mm in two contiguous leads. But STEMI criteria is only 43% sensitive for OMI.[1]

Chest Pain 123

Chest Pain STEMI Myocardial Infarction Ischemia 123