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Early repol or anterior OMI?

Dr. Smith's ECG Blog

He noted that his father died from a heart attack in his early 50s prompting his presentation to the emergency department. This ECG is highly concerning for LAD occlusion despite it not showing a STEMI criteria. Here is the initial ECG at 13:17 with no prior ECG in the patient’s chart for comparison: What do you think?

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46 year old with chest pain develops a wide complex rhythm -- see many examples

Dr. Smith's ECG Blog

He reported a history of “Wolf-Parkinson-White” and “heart attack” but said neither had been treated. This has been discussed many times before on this blog. In-depth discussion is beyond the scope of this blog. The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI.

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A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Dr. Smith's ECG Blog

50% of LAD STEMIs do not have reciprocal findings in inferior leads, and many LAD OMIs instead have STE and/or HATWs in inferior leads instead. The ECG easily meets STEMI criteria in all leads V2-V6, as well. 24 yo woman with chest pain: Is this STEMI? This is not "diffuse", this is simply anterior, lateral, and likely apical.

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A man in his 70s with chest pain

Dr. Smith's ECG Blog

He stated it was similar to prior heart attacks. Both hyperacute T waves and posterior OMI are now formally endorsed as "STEMI equivalents" by the ACC. == MY Comment, by K EN G RAUER, MD ( 11/23 /2022 ): == Cases in which initial ECG findings are subtle before undergoing dramatic change, — are always impressive.

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Circumflex Occlusion May be Subtle or Invisible on the ECG

Dr. Smith's ECG Blog

male presents because he "thought he might be having a heart attack." First, this patient had a known stent in the "marginal" artery and thought he was having a heart attack. By definition, this is a non-STEMI because there is not 1 mm of ST elevation in 2 consecutive leads. How can you make the diagnosis?

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A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

He reportedly told his family "I think I'm having a heart attack", then they immediately drove him to the ED, and he was able to ambulate into the triage area before he collapsed and became unresponsive. CPR was initiated immediately. He had multiple cardiac arrests with ROSC regained each time.

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