EMS 12-Lead

APRIL 2, 2022

Figure 1-1 My colleague, a faithful student of ECG interpretation, handed me the tracing and said that it warranted STEMI activation because of apparent terminal QRS distortion (TQRSD) in V2. Anecdotally, had there been symptoms unequivocally consistent with ACS then one could justifiably make the case for a potential D1 occlusion.

ALS 130

ALS STEMI Coronary OR 130

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

Smith : there is some minimal ST elevation in V2-V6, but does not meet STEMI criteria. Transient STEMI has been studied and many of these patients will re-occlude in the middle of the night. No wall motion abnormality This shows that significant ACS can have ZERO WMA!! Is it normal STE? This is a "Transient OMI".

STEMI 115

STEMI ACS Critical Care Coronary 115

Dr. Smith's ECG Blog

APRIL 26, 2017

Note 2 other similar cases at the bottom that come from my book, The ECG in Acute MI. This meets "STEMI criteria" However, there is very high voltage, with a very deep S-wave in V2 and tall R-wave in V4. The morphology is not right for STEMI. This is very good evidence that the ST elevation is not due to STEMI.

STEMI 52

STEMI ACS ED Coronary 52

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

Troponin T peaked at 2074 ng/L (very high, typical of OMI/STEMI). Here is an example of isolated RV infarction, from Dr. Smith's book : Learning points: 1) OMI can be very subtle and RV infarction may manifest poorly on the standard ECG. Post PCI the patient became gravely hypotensive and "shocky". The LV EF was 57% at formal echo.

STEMI 116

STEMI ACS OR ALS 116

Dr. Smith's ECG Blog

MARCH 17, 2025

Discussion: This case highlights many important points worthy of discussion, mainly because it represents very routine care for ACS but there are so many ways we could improve outcomes with tools we already have! Limitations of registry data: This patient presented with STEMI (-) OMI and developed STEMI the following day.

ACS 81

ACS STEMI Coronary ALS 81