Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" All are, however, clearly massive STEMI. This is her ECG: An obvious STEMI, but which artery? Widimsky P et al.

Coronary 52

Coronary STEMI ACS ALS 52

Dr. Smith's ECG Blog

JULY 14, 2023

Two recent interventions have proven in randomized trials to improve neurologic survival in cardiac arrest: 1) the combination of the ResQPod and the ResQPump (suction device for compression-decompression CPR -- Lancet 2011 ) and 2) Dual Sequential defibrillation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

E-9-1-1 98

E-9-1-1 Defibrillator CPR STEMI 98

Dr. Smith's ECG Blog

NOVEMBER 19, 2014

Furthermore, among 35 patients with acute left main coronary artery occlusion, 9 presented with RBBB (mostly with LAH) on the admission ECG. Here are three more dramatic cases that illustrate RBBB + LAFB Case 1 of cardiac arrest with unrecognized STEMI, died.

CPR 52

CPR STEMI Coronary ALS 52

Dr. Smith's ECG Blog

APRIL 8, 2016

Here is his ED ECG: There is obvious infero-posterior STEMI. What are you worried about in addition to his STEMI? Comments: STEMI with hypokalemia, especially with a long QT, puts the patient at very high risk of Torsades or Ventricular fibrillation (see many references, with abstracts, below). There is atrial fibrillation.

STEMI 52

STEMI Plasma Defibrillator OR 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. Note that they finally have laid to rest the new or presumably new LBBB as a criteria for STEMI. Note that they finally have laid to rest the new or presumably new LBBB as a criteria for STEMI. Kurkciyan et al.

STEMI 52

STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

It was witnessed, and CPR was performed by trained individuals. She arrived in the ED 37 minutes after 911 was called, with continuing CPR. The last section is a detailed discussion of the research on aVR in both STEMI and NonSTEMI. Updates on the Electrocardiogram in Acute Coronary Syndromes. see below). References : 1.

Defibrillator 52

Defibrillator ACS CPR STEMI 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

It may be difficult to read STEMI in the setting of RBBB. There is, however, a long QT also, with abnormal T-waves, but this is not STEMI. This ECG was recorded prehospital, and the computer read STEMI, so the medics activated the cath lab: What do you think? The ECG is consistent with high lateral STEMI. Called 911.

STEMI 40

STEMI CPR CAD Coronary 40

Dr. Smith's ECG Blog

OCTOBER 3, 2017

The assay at my institution, for example, is frequently negative until 4-6 hours after acute coronary occlusion. This rhythm reportedly produced no palpable pulse, and CPR was continued. 30 seconds later, however, the patient began spontaneously moving and CPR was discontinued.

CPR 52

CPR Defibrillator STEMI ED 52

Dr. Smith's ECG Blog

OCTOBER 24, 2013

He underwent immediate CPR, was found to be in ventricular fibrillation, and was successfully resuscitated. He underwent coronary stenting (uncertain which artery). See explanation below. The patient went home and, in front of his wife, he collapsed. I do not have the post-resuscitation ECG.

CPR 52

CPR ACS Coronary OR 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. And so it is wise to look at the coronary arteries. This ECG certainly looks like myocarditis, and was due to myocarditis, but missing acute coronary occlusion is not acceptable.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

JUNE 11, 2021

Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology. Any indications for cath lab activation?

EMR 52

EMR STEMI CPR ED 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

He underwent CPR and then was shocked out of VF. 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.

Coronary 52

Coronary Heart Attack ED CPR 52

EMDocs

JANUARY 11, 2024

Data that do not establish neurological risk stratification in the first 6 hours after CA include the patient’s age, duration of CPR, seizure activity, serum lactate level or pH, Glasgow motor subscore in patients who received NMB or sedation, pupillary function in patients who received atropine, and optic nerve sheath diameter (95.3%, 20/21).

Critical Care 97

Critical Care E-9-1-1 OR ICU 97

Dr. Smith's ECG Blog

OCTOBER 10, 2022

CPR was initiated immediately. As in all ischemia interpretations with OMI findings, the findings can be due to type 1 AMI (example: acute coronary plaque rupture and thrombosis) or type 2 AMI (with or without fixed CAD, with severe regional supply/demand mismatch essentially equaling zero blood flow).

ACS 52

ACS CPR CAD Heart Attack 52

Dr. Smith's ECG Blog

MARCH 11, 2016

cm diameter in the apex The presence of thrombus led the clinicians to state that this was a "late presentation STEMI." It does take some time for thrombus to form, but the EKG and the troponin profile show that this was NOT a late presentation STEMI. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries.

ALS 52

ALS STEMI OR CPR 52

Dr. Smith's ECG Blog

MARCH 8, 2025

The arterial pressure waveform is transduced using the coronary catheter. Normally, the diameter of the coronary artery ostium is much greater than the diameter of the catheter so that catheter engagement does not significantly impair antegrade coronary perfusion. Here is the ECG and arterial waveform during RCA angiography.

E-9-1-1 75

E-9-1-1 OR Defibrillator Coronary 75