Dr. Smith's ECG Blog

JUNE 11, 2024

Now it is a full blown STEMI of 3 myocardial territories: inferior, posterior, and lateral But at least it does not call it "Normal." Learning Points: You cannot trust conventional algorithms even to find STEMI(+) OMI, even when they say "normal ECG." At this point — a STEMI was diagnosed, and cardiac cath with PCI was performed.

STEMI 113

STEMI Coronary Emergency Department OR 113

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 116

STEMI OR Emergency Department 116

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 120

Coronary STEMI Emergency Department OR 120

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 118

STEMI Coronary ALS OR 118

Dr. Smith's ECG Blog

MAY 13, 2024

Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain. which is concerning for LAD occlusion.

OR 120

OR STEMI Heart Attack Coronary 120

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI. Is there STEMI?

STEMI 107

STEMI Coronary Heart Attack ACS 107

Dr. Smith's ECG Blog

JANUARY 20, 2024

Written by Pendell Meyers A man in his late 30s with history of hypertension, tobacco use, and obesity presented to the Emergency Department for acute chest pain which started approximately 3 hours prior to arrival, in the setting of a very stressful situation. The pain radiated down both arms, 10/10 in severity.

STEMI 120

STEMI CAD ED ALS 120

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. Accessed May 28, 2024. What do you think? Labs obtained and notable for an elevated troponin I to 0.10

E-9-1-1 138

E-9-1-1 ACS Emergency Department Coronary 138

REBEL EM

FEBRUARY 3, 2025

Background: ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring rapid diagnosis and intervention. While ECGs play a central role in detecting STEMI, misinterpretations often occur, leading to unnecessary catheterization or missed diagnoses. Annals of Emergency Medicine.

STEMI 84

STEMI Coronary Emergency Department ALS 84

ACEP Now

FEBRUARY 11, 2025

Around the world, acute pain is the most common reason for patients to present to the emergency department (ED). Identifying patients presenting in pain to the adult emergency department: a binary classification task and description of prevalence. Int Emerg Nurs. link] Published June 17, 2024. 2019;12:59-66.

Emergency Department 80

Emergency Department E-9-1-1 ALS ED 80

Dr. Smith's ECG Blog

NOVEMBER 10, 2024

The is very small STE in III and aVF which do not meet STEMI criteria, hyperacute T waves, reciprocal TWI in aVL, and maximal STD in V2-V3 showing posterior OMI. The ECG was transmitted to the Emergency Medicine physician who recognized inferior and posterior OMI findings, and confirmed that the patient has potential ACS symptoms.

STEMI 81

STEMI OR ED EMS 81

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.

STEMI 105

STEMI Coronary Critical Care ED 105

Dr. Smith's ECG Blog

DECEMBER 31, 2024

She presented to the Emergency Department at around 3.5 Final Diagnosis: "STEMI" (of course, as you can see in the ECGs above, this is not true, by definition this was NSTEMI. But the "final diagnosis" commonly just reflects whether the patient was given emergent therapy or not, regardless of the definition of STEMI/NSTEMI).

Coronary 118

Coronary ACS STEMI CAD 118

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

He presented to the emergency department for evaluation. 50% of LAD STEMI have Q-waves by one hour. Smith : In limb leads, the ST vector is towards lead II (STE lead II STE lead III, which is more likely with pericarditis than with STEMI). Lets us consider two different clinical presentations. See Raitt et al.:

STEMI 89

STEMI ALS OR Coronary 89