ACS Coronary Defibrillator 
Dr. Smith's ECG Blog
JULY 25, 2024
He was defibrillated into VT. He then underwent dual sequential defibrillation into asystole. But cardiac arrest is a period of near zero flow in the coronary arteries and causes SEVERE ischemia. Then assume there is ACS. It also does not uniformly indicate severe coronary disease. They started CPR.
Dr. Smith's ECG Blog
OCTOBER 20, 2024
The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). The arrhythmia spontaneously converted before defibrillation was achieved. This is an ominous sign.
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Dr. Smith's ECG Blog
APRIL 2, 2024
He was defibrillated, but they also noticed that he was being internally defibrillated and then found that he had an implantable ICD. He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED. There was no bystander CPR. The QRS is extremely wide.
EMDocs
JANUARY 8, 2024
Emergent coronary angiography is not recommended over a delayed or selective strategy in patients with ROSC after cardiac arrest in the absence of ST-segment elevation, shock, electrical instability, signs of significant myocardial damage, and ongoing ischemia (Level 3: no benefit). COR 2b, LOE C-LD. COR 3, No benefit, LOE B-R.
The Skeptics' Guide to EM
SEPTEMBER 11, 2021
Defibrillation is the treatment of choice in these cases but does not often result in sustained ROSC ( Kudenchuk et al 2006). Acute coronary syndrome (ACS) is responsible for the majority (60%) of all OHCAs in patients. Half of these arrests are witnessed with the other half being un-witnessed.
Dr. Smith's ECG Blog
SEPTEMBER 3, 2023
More past history: hypertension, tobacco use, coronary artery disease with two vessel PCI to the right coronary artery and circumflex artery several years prior. This is diagnostic of ACS; it appears to be a reperfused acute inferior OMI. VF was refractory to amiodarone, lidocaine, double-sequential defibrillation, esmolol, etc.
Dr. Smith's ECG Blog
SEPTEMBER 25, 2024
Here is the post shock ECG: Cardiology was called stat for ischemic VT, query SCAD vs thrombotic occlusion vs coronary vasospasm. Cath lab was activated: There was no coronary artery disease, but there was spontaneous coronary artery dissection (SCAD) of the distal LAD, which was narrowed by 95%, and treated medically.
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