Dr. Smith's ECG Blog

OCTOBER 28, 2013

Updates on the Electrocardiogram in Acute Coronary Syndromes. Current Emergency and Hospital Medicine Reports (2013) 1:4352. Electrocardiogram patterns in acute left main coronary artery occlusion. The patient was discharged neurologically intact. References : 1. Nikus KC, Eskola MJ. J Electrocardiol. 2008;41(6):6269.

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Defibrillator ACS CPR STEMI 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

It is our job to identify this entity and ensure these patients receive the same care they would for a STEMI in any other coronary artery territory. Therein lies the limitation of electrocardiography in diagnosing acute coronary occlusion. Tips for recognizing Acute Posterior STEMI: 1. Neth Heart J. 2007; 15: 16-21. Wung SF, Drew BJ.

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STEMI E-9-1-1 Coronary ALS 52

Dr. Smith's ECG Blog

OCTOBER 8, 2018

However, I was a little unsure on scene whether it was a problem of his coronaries." "But Steffen wrote: " I remembered the ECG from your blog titled: "STEMI Seen Best in PVC, Diagnosed by Medic, Ignored by Physician" from 2013. Surprisingly enough he had undertaken a tour on the bike just two days ago without any complaints." "He

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STEMI Coronary OR 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58).

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Coronary ACS ALS STEMI 40

EMDocs

OCTOBER 30, 2023

3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013. CT scans have become an integral part of the ED diagnostic process, serving as a diagnostic tool to aid in determining appropriate disposition, risk assessment, and guiding admission decisions.

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E-9-1-1 Emergency Department ALS CCT 101

REBEL EM

FEBRUARY 22, 2023

Philadelphia: Elsevier, 2013 (Ch) 26: p. et al, Emergency Medicine Clinical Essentials ed 2. 209-225 Walker R, Adhikari S.: Eye Emergencies, in Tintinalli J et al (eds): Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, Seventh Edition New York City: McGraw-Hill 2016 (Ch) 241 Guluma K, Lee JE.

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Emergency Department ALS ED Coronary 52

Dr. Smith's ECG Blog

JUNE 1, 2022

Moreover, the research which appears to confirm this idea was indeed in relation to the circumflex, but they did not study Occlusion ; rather, they studied asymptomatic coronary disease. I showed conclusively that this is a common finding in normal ECGs, though it is more common in LAD Occlusion than in norml variant STE.

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STEMI Coronary OR ALS 52

REBEL EM

MARCH 22, 2023

Resources REBEL EM: SVT with Aberrancy Versus VT Amal Mattu’s ECG Case of the Week: August 26th, 2013 ALiEM: Tricks of the Trade: Valsalva Maneuver By Using a 10cc Syringe Larry Mellick: Treating SVT with Adensoine ALiEM: Trick of the Trade: Combining Adenosine with the Flush References Brugada P et al.

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ALS EMS ED OR 52

Dr. Smith's ECG Blog

JUNE 30, 2023

Along the way to acquiring more experience in recognizing the ECG findings of acute coronary occlusion — is incorporation of a number of KEY ECG Features into one's clinical acumen. Although this is not a common phenomenon — You will see it on occasion ( See the July 24, 2013 post , among others — in Dr. Smith's ECG Blog ).

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E-9-1-1 Coronary ED OR 52

Dr. Smith's ECG Blog

APRIL 22, 2022

Int J Cardiol 2013 2. Identifying patients with low risk for acute coronary syndrome without troponin testing: validation of the HEAR score. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. Backus BE, Six AJ, Kelder JC, et al. Shin YS, Ahn S, Kim YJ.

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E-9-1-1 STEMI ALS ED 52

Dr. Smith's ECG Blog

DECEMBER 12, 2022

This " imbalance of precordial T waves" is not seen very often — and in the “right” clinical setting, has been associated with recent OMI from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM ).

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OR ACS STEMI Coronary 52

Dr. Smith's ECG Blog

FEBRUARY 16, 2019

Posterior STEMI" may not even technically exist according to the current (2013) ACC/AHA STEMI guidelines, as it is not described as a "STEMI equivalent" and the only relevant statement in the guidelines is: "In addition, ST depression in 2 precordial leads (V1-V4) may indicate transmural posterior injury." Comment from K. What is "STEMI"?

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STEMI E-9-1-1 ACS OR 52

Dr. Smith's ECG Blog

AUGUST 22, 2020

PEARL #2 — As emphasized by Dr. Smith in the July 24, 2013 post in Dr. Smith’s ECG Blog — the ST-T wave appearance in repolarization variants may be dynamic ! The angiogram showed completely normal vessels ( No evidence of coronary disease! ). As a result — I thought cardiac cath was clearly indicated to clarify the clinical picture.

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Coronary ED OR 40

The Skeptics' Guide to EM

OCTOBER 20, 2018

The acute coronary syndrome work-up is negative but she is Well’s high and needs a CTPA to rule-out a pulmonary embolism. Background: There has been a huge increase in the number of CT scans performed with more than 75 million CT scans performed in the US in 2013. Case: A 64-year-old woman with type-2 diabetes.

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Coronary Emergency Department ALS OR 181

Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" Furthermore, among 35 patients with acute left main coronary artery occlusion, 9 presented with RBBB (mostly with LAFB) on the admission ECG.

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Coronary STEMI ACS ALS 52

REBEL EM

SEPTEMBER 28, 2023

STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. Based on this, the authors did a literature review and found that there is an increasing rate of ICH and major non-intracranial bleeding starting at ≈60 years of age.

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STEMI Allergic Reaction Coronary Ambulance 138

REBEL EM

JANUARY 29, 2024

Am J Cardiol 2013. A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Reisk Pulmonary Embolism: The OPTALYSE PE Trial. JACC Cardiovasc Interv 2018. PMID: 30025734 Sharifi M et al. Moderate Pulmonary Embolism Treated with thrombolysis (from the “MOPETT” Trial). Clin Exp Emerg Med 2023.

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ALS ACS OR CPR 136

Dr. Smith's ECG Blog

MAY 8, 2023

Electrocardiographic Diagnosis of Acute Coronary Occlusion Myocardial Infarction in Ventricular Paced Rhythm Using the Modified Sgarbossa Criteria. Immediate ECG diagnosis of an acute coronary lesion resulting in occlusion myocardial infarction is critical in the modern reperfusion era. Annals of Emergency Medicine 2021.

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STEMI Coronary ED ACS 52

REBEL EM

SEPTEMBER 12, 2022

Background: Coronary artery disease can result in hibernating myocardium (chronic myocardial contractile dysfunction) due to ischemia. The theory is that there is reduced coronary blood flow and increased myocardial demand resulting in impaired contractility. Paper: Perera D et al. OMT: 38.0% HR 0.99; 95% CI 0.78 to 1.27; p = 0.96

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Coronary ALS OR EMS 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Rather it is due to coronary insufficiency due to a tight left main or 3-vessel disease with inadequate coronary flow. Fourteen (16%) of the 86 patients who had CT also had immediate cardiac catheterization for acute ischemic changes; 7 of which had primary percutaneous coronary intervention (PCI).

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STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

JULY 22, 2023

The patient proceeded to cath where all coronaries were described as normal with no evidence of any CAD, spasm, or any other abnormality. PM Cardio digitized version. QOH Interpretation: The initial troponin I (older generation) at the first ED was barely positive at 0.06

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E-9-1-1 CAD OR STEMI 92

Dr. Smith's ECG Blog

NOVEMBER 24, 2017

Am J Cardiol 12(9):1379-1383; Nov 2013. Among patients with left bundle branch block, T-wave peak to T-wave end time is prolonged in the presence of acute coronary occlusion. Musat DL et al. Correlation of QT Interval Correction Methods During Atrial Fibrillation and Sinus Rhythm. Unfortunately, the topic is very complex.

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ALS OR ED Coronary 52

Don't Forget the Bubbles

DECEMBER 5, 2023

A 2013 study found that half of young Australians are dissatisfied with school-based sex education. The goal of chest compressions during neonatal resuscitation is to increase cerebral and coronary blood flow with the intention to achieve a return of spontaneous circulation (ROSC). Why does it matter? Sex ed” sucks.

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Coronary Epinephrine CPR Emergency Department 111

ACEP Now

JUNE 14, 2024

Some of the critical differentials include pulmonary embolism, acute decompensated heart failure, pneumonia, pneumothorax, and acute coronary syndrome. Anginal chest pain, chest heaviness, or evidence of fluid overload suggest acute coronary syndrome or acute decompensated heart failure. Signs and symptoms of systemic infection (e.g.,

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ALS Coronary OR ED 52

Dr. Smith's ECG Blog

APRIL 13, 2025

Myocardial Infarction with Non-Obstructive Coronary Arteries. Etiologies (list not comprehensive): Coronary Spasm. Provocative testing is very helpful for this Coronary Thrombus with lysis (one must do optical coherence tomography or at least intravascular ultrasound to find thes non-obstructive plaques that ruptured.

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Coronary STEMI EMS ALS 83

EMDocs

NOVEMBER 13, 2023

Am Surg 2013, 79 (1), 23-29. Eur Radiol 2013, 23 (6), 1443-1449. Neurology 2013, 81 (11), 1004-1011. AJNR Am J Neuroradiol 2013, 34 (5), 1077-1081. Contrast-induced acute kidney injury in patients with renal dysfunction undergoing a coronary procedure and receiving non-ionic low-osmolar versus iso-osmolar contrast media.

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E-9-1-1 ALS Emergency Department ED 106

Dr. Smith's ECG Blog

APRIL 9, 2025

Lidocaine had been used for the prevention of VF since the 1960s after coronary care units became a standard setting for the treatment of AMI. Primary VF in this study refers to fibrillation occurring in the absence of shock or pulmonary edema. Mortality rate, when primary VF occurs, is 2 to 4 times greater than when it does not.

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Defibrillator STEMI ED OR 63

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Rates of occurrence of PIRP have decreased drastically in the era of percutaneous coronary intervention. Incidence and Prognosis of Pericarditis After ST-Elevation Myocardial Infarction (from the Acute Coronary Syndrome Israeli Survey 2000 to 2013 Registry Database). of patients developed PIRP [ 1 ]. Oliva et al. [ Hammill, S.

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STEMI ALS OR Coronary 88

Dr. Smith's ECG Blog

MARCH 8, 2025

The arterial pressure waveform is transduced using the coronary catheter. Normally, the diameter of the coronary artery ostium is much greater than the diameter of the catheter so that catheter engagement does not significantly impair antegrade coronary perfusion. Here is the ECG and arterial waveform during RCA angiography.

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E-9-1-1 OR Defibrillator Coronary 74