Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

A middle-aged male with h/o CAD and stents presented with typical chest pressure. It is highly associated with proximal LAD occlusion or severe left main ACS and with bad outcomes. Here is his ECG: The resident was alarmed at the "ST elevation in III with reciprocal ST depression in aVL" Are you alarmed? This is a very common misread.

STEMI 52

STEMI CPR CAD Coronary 52

Dr. Smith's ECG Blog

OCTOBER 26, 2020

In total, he received approximately 40 minutes of CPR and 7 defibrillation attempts. The patient was transferred immediately for angiogram which revealed no significant CAD, and no intervention was performed. Learning Points: The myocardium doesn't know the etiology of OMI (ACS, spasm, dissection, embolus, etc.),

Coronary 52

Coronary Defibrillator ACS CAD 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

CPR was initiated immediately. If this is ACS with Aslanger's pattern , the ST depression vector of subendocardial ischemia (due to simultaneous 3 vessel or left main ACS) is directed toward lead II (inferior and lateral). It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation.

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ACS CPR CAD Heart Attack 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

But if they do present: The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion , though it might be due to sub total LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. Beware crescendo angina in patient with known CAD ST Elevation in aVR Case 7.

Coronary 52

Coronary STEMI ACS ALS 52