Dr. Smith's ECG Blog

JANUARY 27, 2024

, tells us that we physicians do not need to even look at this ECG until the patient is placed in a room because the computer says it is normal: Validity of Computer-interpreted “Normal” and “Otherwise Normal” ECG in Emergency Department Triage Patients I reviewed this article for a different journal and recommended rejection and it was rejected.

STEMI 110

STEMI Coronary ACS ED 110

EMDocs

OCTOBER 28, 2023

2023 Sep;164(3):667-669. Epub 2023 Apr 20. #2: 2: STREAM-2 RCT | Half-Dose Tenecteplase for STEMI Spoon Feed The STREAM-2 trial found half-dose tenecteplase was effective in treating STEMI patients ≥60, though with increased risk of intracranial hemorrhage. 2023 Aug 29;148(9):753-764. Epub 2023 Jul 13. #3:

STEMI 66

STEMI Emergency Department Coronary OR 66

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. I refer to My Comment in the March 4, 2023 post — in which I included a Table with ECG Findings of Acute PE.

E-9-1-1 141

E-9-1-1 ACS Emergency Department Coronary 141

EMDocs

SEPTEMBER 14, 2024

Source Use of Glucagon-Like Peptide-1-Agonists and Increased Risk of Procedural Sedation and Endotracheal Intubation in the Emergency Department. Ann Emerg Med. 2023-064364. 2024 Aug;84(2):226-227. DOI: 10.1016/j.annemergmed.2024.03.007. 2024.03.007. PMID: 39032988. #2: Pediatrics. 2024 Jul 1;154(1):e2023064364.

Defibrillator 71

Defibrillator STEMI Emergency Department OR 71

ACEP Now

DECEMBER 11, 2023

Many conditions outside of acute coronary syndrome (ACS) mimic ST-elevation myocardial infarction (STEMI), but only a handful of cases have reported ST-elevations (STE) in the setting of pancreatic inflammation where underlying ACS was excluded. Mimics of ST elevation myocardial infarction (STEMI). Accessed November 29, 2023.

STEMI 52

STEMI Coronary ACS Critical Care 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.

Defibrillator 137

Defibrillator Coronary STEMI CPR 137

Dr. Smith's ECG Blog

SEPTEMBER 8, 2023

A 50 year old presented to the emergency department of a remote rural community (where the nearest cath lab is a plane ride away) with one hour of mild chest pain radiating to the back and jaw, and an ECG labeled ‘normal’ by the computer interpretation.

OR 133

OR STEMI Coronary Emergency Department 133

Dr. Smith's ECG Blog

DECEMBER 29, 2023

It was ongoing on arrival in the emergency department. But because there was no new ST elevation, the ECG was signed off as “STEMI negative” and the patient waited to be seen. The emergency physician was called to see the patient 90 minutes later after the troponin I returned at 1100 ng/L. What do you think? Take home 1.

STEMI 74

STEMI Coronary OR ALS 74

Dr. Smith's ECG Blog

MAY 23, 2023

Notice on the right side of the image how the algorithm correctly measures STE sufficient in V1 and V2 to meet STEMI criteria in a man older than age 40. As most would agree, this ECG shows highly specific findings of anterolateral OMI, even with STEMI criteria in this case. Thus, this is obvious STEMI(+) OMI until proven otherwise.

STEMI 93

STEMI Coronary Paramedic OR 93

Dr. Smith's ECG Blog

SEPTEMBER 5, 2023

Quiz : What percent of full blown STEMI have an open artery with normal flow at angiogram? It too is "normal" and you decide that this is not OMI or STEMI and you just decide to get troponins. I would expect TIMI-3 flow (normal flow, no persistent ischemia) with a culprit in the RCA (or possibly Circumflex).

STEMI 88

STEMI Emergency Department OR ALS 88

Dr. Smith's ECG Blog

JUNE 18, 2013

His ECG was repeated at this point: This shows a well developed anterior STEMI. To not see these findings is very common, and this patient would be given the diagnosis of NonSTEMI, with subsequent development of STEMI. It is not a missed STEMI, but it is a missed coronary occlusion. Ann Emerg Med 1998;31(1):3-11.

STEMI 52

STEMI Coronary ALS CAD 52

ACEP Now

AUGUST 12, 2024

A 35-year-old male presented to the emergency department complaining of chest pain that started 1.5 5 Studies looking at this phenomenon in the emergency department setting for patients presenting with chest pain are lacking. Dr. Young is an emergency physician at Saint Francis Hospital and Medical Center, Hartford, Conn.

Emergency Department 52

Emergency Department STEMI ACS ED 52

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion. At 2111, the troponin I peaked at 12.252 ng/mL (this is in the range of STEMI patients, quite high).

Coronary 116

Coronary STEMI Emergency Department OR 116

Dr. Smith's ECG Blog

AUGUST 4, 2024

QOH versions 1 and 2 both say Not OMI, with high confidence, without any clinical context, despite the abnormal STE meeting STEMI criteria. Context: a man in his 40s presented to the emergency department with 1 day of sudden onset chest pain. I sent this to our group without information and Dr. Smith responded: "Not OMI.

STEMI 103

STEMI OR Emergency Department 103

ACEP Now

APRIL 4, 2024

A 59-year-old male with a past medical history of a repaired ventricular septal defect (VSD), dextrocardia, hypertension, hyperlipidemia, and current smoker presented to the emergency department (ED). Figure 1: EKG for Dextrocardia showing STEMI. The second EKG was concerning for STEMI in the precordial leads (see figure 1).

Coronary 40

Coronary STEMI CAD Emergency Department 40

Dr. Smith's ECG Blog

JANUARY 1, 2024

AslangerE A 65-year-old gentleman presented to the emergency department after experiencing two recent ICD shocks in the preceding hours. As per Dr. Aslanger — a number of medical providers were initial confused by what initially appears as marked ST elevation with reciprocal ST depression, indicative of an acute STEMI.

Coronary 105

Coronary EMR STEMI Emergency Department 105

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

20% of cases that everyone would call a STEMI have a competely open artery by the time of angiogram 60-90 minutes later. Patient stated that he has had glucose over 400 even though he has not missed any doses of insulin. He also endorses fatigue, upset stomach, frequent urination, increased thirst, and decreased apatite over the past 2 days.

ED 111

ED Coronary CAD STEMI 111

Dr. Smith's ECG Blog

APRIL 17, 2023

The remainder of his Emergency Department stay was uneventful. The Queen of Hearts correctly says: Smith : Why is this ECG which manifests so much ST Elevation NOT a STEMI (even if it were a 60 year old with chest pain)? Physician interpretation: "No STEMI." Physician: "No STEMI." He had no symptoms of ACS.

OR 52

OR STEMI ACS Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 25, 2023

A man in his 60s with a history of severe alcohol use disorder and epidural abscess on long-term ciprofloxacin presented to the emergency department after an episode of syncope while standing in line at a grocery store. Is it STEMI? Written by Sean Trostel MD, peer reviewed by Meyers, Smith, Grauer, etc. What is going on here?

Overdose 120

Overdose OR ACS ICU 120

ACEP Now

JULY 6, 2023

Emergency physicians have earned the right to “re-brand” ourselves as indispensable, money-saving change agents in the health care enterprise. Of course, the bill for any episode of emergency department (ED) care can be substantial, exceeding the billed charges for equivalent care provided in some primary care offices.

ALS 52

ALS Emergency Department STEMI ED 52

Dr. Smith's ECG Blog

MARCH 9, 2023

Sent by anonymous, written by Pendell Meyers A man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chest pain. Barely any STE, and thus not meeting STEMI criteria. Only now that the patient has STEMI criteria is he allowed to go to the cath lab, at around 0530.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

MARCH 20, 2023

I finished my residency of Emergency Medicine and I’m working at a great Emergency Department here in Brazil. Since then, I started looking for OMI EKG findings and not just STEMI. mm in lead I, thus not STEMI criteria) and was finally understood by the cardiologist. Teaching is rewarding!

STEMI 52

STEMI ACS CAD ED 52

Dr. Smith's ECG Blog

MARCH 6, 2023

Here is the repeat ECG at 52 minutes after arrival to triage: Obvious posterolateral STEMI Angiographic findings: 1. 2022 ACC expert consensus decision pathway on the evaluation and disposition of acute chest pain in the emergency department: A report of the American college of cardiology solution set oversight committee. •

OR 52

OR STEMI ED Critical Care 52

Dr. Smith's ECG Blog

MAY 1, 2023

edits by Meyers A woman in her 60s with a history of chronic atrial fibrillation on Eliquis, ESRD on hemodialysis, type-II diabetes mellitus, prior CVA, hypertension, and hyperlipidemia presented to the emergency department with multiple complaints after missing dialysis. Is this inferor STEMI? Tachycardia and ST Elevation.

OR 52

OR STEMI Emergency Department 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. My Comment by K EN G RAUER, MD ( 1/23 /2023 ): = The importance of today's case by Drs.

ACS 52

ACS Coronary Defibrillator STEMI 52

Dr. Smith's ECG Blog

JANUARY 17, 2024

The limb leads have been removed because there was no ST elevation in those leads, the QRS complexes have been obscured because this is irrelevant to STEMI criteria, and red lines have been added to measure ST segment elevation. But STEMI criteria ignore all this and look at ST segments in isolation.

STEMI 108

STEMI Coronary ALS OR 108

Dr. Smith's ECG Blog

AUGUST 10, 2023

Case submitted and written by Dr. Mazen El-Baba and Dr. Emily Austin, with edits from Jesse McLaren A 50 year-old patient presented to the Emergency Department with sudden onset chest pain that began 14-hours ago. This doesn’t meet STEMI criteria so in the current paradigm there’s no urgency to getting an angiogram.

STEMI 93

STEMI ACS Emergency Department ED 93

Dr. Smith's ECG Blog

OCTOBER 13, 2023

There is worrisome T-wave inversion in inferior leads as well, which is another clue to LAD Occlusion In fact, this ECG meets STEMI criteria!! Why does the conventional algorithm not diagnose STEMI? Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04

STEMI 116

STEMI OR Coronary Emergency Department 116

Dr. Smith's ECG Blog

MARCH 24, 2023

There’s minimal concave ST elevation in III which does not meet STEMI criteria, so this ECG is "STEMI negative". Use STEMI criteria to identify acute coronary occlusion: the ECG was STEMI negative 2. A repeat ECG was done on way to cath lab: "STEMI negative" again. The cath lab was activated. Take home 1.

STEMI 52

STEMI Coronary CAD OR 52