Dr. Smith's ECG Blog

JUNE 21, 2023

Below is the version standardized by PM Cardio app Meyers interpretation: Findings are specific for posterior (and also likely inferior) wall transmural acute infarction, most likely due to acute coronary occlusion (OMI). Smith Comment: Is is common for the artery to be open at angiogram in OMI, including full STEMI.

STEMI 98

STEMI Coronary Defibrillator EMS 98

Dr. Smith's ECG Blog

MAY 19, 2020

She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). After good ECMO flow was established, she was successfully defibrillated. Here is a case of ECMO defibrillation with near shark fin that was due to proximal LAD occlusion. The K was normal.

Defibrillator 52

Defibrillator CPR Coronary CAD 52

Dr. Smith's ECG Blog

APRIL 24, 2015

Again, it is common to have an ECG that shows apparent subendocardial ischemia after resuscitation from cardiac arrest, after defibrillation, and after cardioversion. Ventricular fibrillation is not only caused by acute coronary syndrome. We found that 38% of out of hospital ventricular fibrillation was due to STEMI.

Defibrillator 52

Defibrillator ACS CAD STEMI 52

Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. It shows a proximal LAD occlusion, in conjunction with a subtotally occluded LMCA ( Left Main Coronary Artery ). He required multiple defibrillations within a period of a few hours. The below ECG was recorded. He was taken immediately to the cath lab.

Defibrillator 131

Defibrillator Coronary ALS STEMI 131

Dr. Smith's ECG Blog

JULY 14, 2023

He underwent further standard resuscitation EXCEPT that we applied the Inspiratory Threshold Device ( ResQPod ) AND applied Dual Sequential Defibrillation (this simply means we applied 2 sets of pads, had 2 defib machines, and defibrillated with both with only a fraction of one second separating each defibrillation.

E-9-1-1 98

E-9-1-1 Defibrillator CPR STEMI 98

Dr. Smith's ECG Blog

JUNE 19, 2023

This ECG was read as “No STEMI” with no prior available for comparison. It is true this ECG does not meet STEMI criteria (there is 1.0 The patient has also developed sinus bradycardia, which may result from right coronary artery ischemia to the SA node. Instead we discussed 5 minute delays for the STEMI(+) OMI patients.

STEMI 52

STEMI ACS Coronary Epinephrine 52

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

There’s inferior ST depression which is reciprocal to subtle lateral convex ST elevation, and the precordial T waves are subtly hyperacute – all concerning for STEMI(-)OMI of proximal LAD. There’s ST elevation I/aVL/V2 that meet STEMI criteria. This is obvious STEMI(+)OMI of proximal LAD. Non-STEMI or STEMI(-)OMI?

STEMI 52

STEMI Paramedic Coronary ALS 52

ECG & Echo Learning

JANUARY 18, 2023

This page summarises the most current recommendations for the management of acute coronary syndromes with persistent ST-segment elevations (i.e STEMI , ST-segment elevation acute myocardial infarction ). STEMI , ST-segment elevation acute myocardial infarction ). due to reciprocal ST-segment depressions in V1, V2, V3).

STEMI 40

STEMI Coronary OR Defibrillator 40

Dr. Smith's ECG Blog

OCTOBER 4, 2010

He was resuscitated with chest compressions and defibrillation and 1 mg of epinephrine. The next day, and angiogram showed normal coronary arteries. Thus, this patient had increased ST elevation (current of injury) superimposed on the ST elevation of LVH and simulating STEMI. His initial ECG is shown here.

ACS 52

ACS Epinephrine Defibrillator STEMI 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? At cath, he immediately had incessant Torsades de Pointes requiring defibrillation 7 times and requiring placement of a transvenous pacer for overdrive pacing at a rate of 80. There is atrial fibrillation.

STEMI 52

STEMI Plasma Defibrillator OR 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

She was found to be in ventricular fibrillation and was defibrillated 8 times without a single, even transient, conversion out of fibrillation. She was immediately intubated during continued compressions, then underwent a 9th defibrillation, which resulted in an organized rhythm at 42 minutes after initial arrest. see below).

Defibrillator 52

Defibrillator ACS CPR STEMI 52

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.

OR 66

OR STEMI ACS Coronary 66

Dr. Smith's ECG Blog

OCTOBER 20, 2013

She was never seen to be in ventricular fibrillation and was never defibrillated. 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. BP gradually rose. Kurkciyan et al.

STEMI 52

STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

DECEMBER 23, 2014

There are a few subtle signs of coronary occlusion here. He was defibrillated. Anterolateral STEMI. He had an ECG recorded: Sinus Rhythm. This was read as normal by the emergency physician and by the computer. QTc is 400 ms. What do you think? First , look at V4-V6. The T-wave is almost as tall as the R-wave. This should not be.

Defibrillator 52

Defibrillator STEMI Coronary 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

She was defibrillated and resuscitated. Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronary artery disease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy. One need not have obstructive coronary disease to have occlusive thrombus!

Emergency Department 52

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

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

There is a very small amount of STE in some of the anterior, lateral, and inferior leads which do NOT meet STEMI criteria. Acute coronary occlusion is the most common and most treatable cause of this pattern, but it is not the only cause. Takotsubo, spasm, low flow with a preexisting stable coronary lesion, etc.

STEMI 52

STEMI Coronary ACS Defibrillator 52

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. After the second defibrillation the patient had an organized rhythm: Bradycardic escape/agonal rhythm, with large ST deviations. A repeat ECG was done: Obvious anterolateral wall STEMI.

CPR 52

CPR Defibrillator STEMI ED 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

When the ICD was finally interrogated, the syncopal events and shocks correlated with two VF events that were defibrillated successfully. 90% stenosis of the proximal ramus intermedius, pre procedure TIMI II flow The ramus intermedius is a normal variant on coronary anatomy that arises between the LAD and LCX.

ACS 52

ACS Coronary Defibrillator STEMI 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. 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.

ACS 52

ACS CPR CAD Heart Attack 52

Dr. Smith's ECG Blog

DECEMBER 31, 2024

Written by Pendell Meyers A woman in her 70s with known prior coronary artery disease experienced acute chest pain and shortness of breath. Her history and ECG were interpreted as very concerning for acute coronary syndrome which might benefit from acute reperfusion therapy. Vital signs were within normal limits. hours since onset.

Coronary 119

Coronary ACS STEMI CAD 119

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

A 12-lead was recorded, showing "STEMI," but is unavailable. Moreover, if you know that catastrophic intracranial hemorrhage can result in an ECG that mimics STEMI, then you know that this patient probably has a severe intracranial hemorrhage. Moreover, it does not follow a coronary distribution very well. From this site.

STEMI 89

STEMI Paramedic E-9-1-1 Epinephrine 89

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. She was defibrillated perhaps 25 times.

E-9-1-1 75

E-9-1-1 OR Defibrillator Coronary 75

Dr. Smith's ECG Blog

NOVEMBER 29, 2024

She underwent coronary angiography which showed thrombotic occlusion of an RPL branch s/p aspiration thrombectomy. Queen : she saw no OMI (no "STEMI Equivalent") either Continued : Now, she says she was walking to the bathroom when she experienced acute onset substernal chest pressure radiating into her neck and left arm.

Defibrillator 66

Defibrillator STEMI Coronary ED 66