2024 CAD STEMI 
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. Similarly, if a patient with known CAD presents with refractory ischemic chest pain, the ECG barely matters: the pre-test likelihood of acute coronary occlusion is so high that they need an emergent angiogram.
Dr. Smith's ECG Blog
JUNE 19, 2024
The ED provider ordered a coronary CT scan to assess the patient for CAD. His EKG with worse pain now shows enough ST elevation to meet STEMI criteria. The EKG was read by the conventional computer algorithm as diagnostic of “ACUTE MI/STEMI”. The patient started receiving medications for “STEMI” (including heparin!!!)
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Dr. Smith's ECG Blog
NOVEMBER 3, 2023
A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. The Queen of Hearts AI app will hopefully be FDA approved in Q1 of 2024. I have not yet seen any case report of this combination.
Dr. Smith's ECG Blog
JANUARY 20, 2024
Scattered other nonobstructive CAD. This patient does not show up in the STEMI registry, and the time to reperfusion will likely not be identified as the problem that it was. Angiogram around 9am: Culprit lesion mid LAD 100% stenosis TIMI 0 TIMI 3 after PCI Severe apical dyskinesis, severe anteroapical akinesis.
Dr. Smith's ECG Blog
DECEMBER 31, 2024
The procedure was described as very complex due to severe multivessel CAD, but ultimately PCI was successfully performed to the ostial LCX. Final Diagnosis: "STEMI" (of course, as you can see in the ECGs above, this is not true, by definition this was NSTEMI. This ECG is taken from the July 25, 2024 post in Dr. Smith's ECG Blog.
Dr. Smith's ECG Blog
NOVEMBER 19, 2024
No prior similar symptoms or known CAD. The Queen of Hearts Diagnosed "STEMI/STEMI equivalent" on that first ECG (she now uses "STEMI Equivalent" rather than OMI). The fact that she states "STEMI-Equivalent" here means that she does not think it is reperfused, but she does not know that the patient is pain free now.
Dr. Smith's ECG Blog
JANUARY 21, 2025
It is correct that he did not have chest pain, but we must remember that fully 1/3 of full blown STEMI do not present with chest pain. This is extremely elevated for a type 2 MI and totally consistent with STEMI. As per Dr. Smith the Troponin peak of 16,000 is much more suggestive of a STEMI than of a Type II MI.
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