High Performance EMS

JANUARY 26, 2021

No one can tell you who will be that very next person to dial 9-1-1; however, it is imperative for the effectiveness of deployment that we concede that people and events often follow certain predictable patterns. Your existing historical CAD records contain the necessary information to build such dynamic views in real-time.

Emergency Response 100

Emergency Response Emergency Medical Services CAD Ambulance 100

Dr. Smith's ECG Blog

MARCH 19, 2023

Concerning history, known CAD" Recorded 2 hours after pain onset: What do you think? To realize — Assessment of ECG #1 is complicated by knowing: i ) That today’s patient has a history of documented CAD ; and , ii ) The lack o f a prior tracing for comparison at the time the initial ECG was interpreted.

STEMI 52

STEMI Coronary CAD OR 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

No family history of sudden cardiac death, cardiomyopathy, premature CAD, or other cardiac issues. There is unfortunately no way to justify the sequence of events with resultant delay in diagnosis and treatment — and ultimate catastrophic infarction that rendered a previously healthy teenager a candidate for cardiac transplantation.

Coronary 52

Coronary STEMI Heart Attack OR 52

Dr. Smith's ECG Blog

MARCH 20, 2023

Angiogram soon after (around 4 hrs after presentation) showed multi vessel CAD, with culprit lesion total occlusion of the first obtuse marginal branch (OM1), which was stented. A repeat ECG at this time is below: The repeat ECG shows more STE (but still not 1.0 No more troponins were obtained. Unfortunately the echo was not available.

STEMI 52

STEMI ACS CAD ED 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. Written by Nathanael Franks MD, reviewed by Meyers, Smith, Grauer, etc. Unfortunately — 1.5

ACS 87

ACS Coronary ALS CAD 87

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

This case represents the same physiologic event as OMI in terms of the result on the myocardium, therefore with identical ECG features, however there may not be ACS! Perhaps this event could have been avoided. The lower heart rate was maintained, as were the ST segment changes above, over the next 10 minutes in the resuscitation room.

STEMI 52

STEMI ACS CAD OR 52

Dr. Smith's ECG Blog

OCTOBER 26, 2020

The patient was transferred immediately for angiogram which revealed no significant CAD, and no intervention was performed. All of these episodes occurred without any symptoms reported from the patient, even after pointed questioning during the telemetry events. I do not see clear evidence of OMI or reperfusion at this time.

Coronary 52

Coronary Defibrillator ACS CAD 52

Dr. Smith's ECG Blog

JULY 22, 2023

The patient proceeded to cath where all coronaries were described as normal with no evidence of any CAD, spasm, or any other abnormality. Recently the rate of true arrhythmic events related to fevers in the classic Brugada Type 1 syndrome was explored by Michowitz et al. Heart Rhythm, 4(2), 198-199. [6]

E-9-1-1 69

E-9-1-1 CAD OR STEMI 69

Dr. Smith's ECG Blog

JULY 11, 2019

He also had non-acute CAD of the RCA (50%) and LCX (50%). Cardiology was called and the patient was taken for urgent catheterization with the time from ED arrival to cath about 1 hour and 45 minutes. 100% proximal LAD thrombotic occlusion with TIMI 0 flow was found and stented with excellent angiographic result and TIMI 3 flow.

STEMI 52

STEMI ACS CAD ED 52

Dr. Smith's ECG Blog

JULY 31, 2018

She had zero CAD risk factors. Subsequent events: Later, before being taken to her room, the 2nd troponin returned at 1.01 hours of substernal chest pressure. It was non-radiating and without other associated symptoms except for nausea. Here was her ECG at time zero: What do you think? There is ST elevation in V2 with large fat T-wave.

Coronary 52

Coronary ACS STEMI OR 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

A formal echocardiogram was completed the next day and again showed a normal ejection fraction without any focal wall motion abnormalities to suggest CAD. Recently the rate of true arrhythmic events related to fevers in the classic Brugada Type 1 syndrome was explored by Michowitz et al. There is no further workup at this time.

E-9-1-1 52

E-9-1-1 CAD STEMI OR 52

ECG & Echo Learning

JANUARY 18, 2023

IIa C During hospital stay (after primary PCI) Either stress echo, CMR, SPECT, or PET may be used to assess myocardial ischaemia and viability, including in multivessel CAD. I C During hospital stay (after primary PCI) When echocardiography is suboptimal/inconclusive, an alternative imaging method (CMR preferably) should be considered.

STEMI 40

STEMI Coronary OR Defibrillator 40

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Takotsubo is a sudden event, not one with crescendo angina. J Electrocardiol [Internet] 2022;Available from: [link] Cardiology opinion: Takotsubo Cardiomyopathy (EF 30-35%) V Fib Cardiac arrest Prolonged QTC NSTEMI (Smith comment: is it NSTEMI or is it Takotsubo? -- these are entirely different) Moderate single-vessel CAD.

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

Dr. Smith's ECG Blog

MAY 10, 2023

CAD-RADS category 1. --No Given the already elevated initial troponin — the onus on emergency providers is to rule out an acute event, rather than the other way around. Now, with elevated troponins, Wellens' syndrome is likely. A CT Coronary angiogram was ordered. LAD plaque with 0-25 percent stenosis.

Coronary 52

Coronary STEMI CAD OR 52

Dr. Smith's ECG Blog

MARCH 24, 2023

Written by Jesse McLaren, with comments from Smith An 85 year old with a history of CAD presented with 3 hours of chest pain that feels like heartburn but that radiates to the left arm. The evolution of sequential ECG changes during an acute ongoing event is not always homogeneous. Below is the ECG. What do you think?

STEMI 52

STEMI Coronary CAD OR 52

Dr. Smith's ECG Blog

MARCH 6, 2019

She also had non-acute CAD of the left main (50%) and LCX (75%). While we often advocate for frequent serial ECGs during the early hours of a suspected acute cardiac event — the decision for immediate cath in this case should not depend on waiting around to see what a repeat ECG shows. They opened it. Initial troponin T was 0.46

STEMI 52

STEMI ALS ACS OR 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

As I met the paramedics and cath team in the lab, I was ready to see severe coronary disease (CAD), but the vessels were non-obstructive. Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis.

Coronary 52

Coronary ACS ALS STEMI 52