Remove Defibrillator Remove Definition Remove STEMI
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Resuscitated from ventricular fibrillation. Should the cath lab be activated?

Dr. Smith's ECG Blog

He was defibrillated into VT. He then underwent dual sequential defibrillation into asystole. See these related cases: Cardiac arrest, defibrillated, diffuse ST depression and ST Elevation in aVR. Cardiac arrest #3: ST depression, Is it STEMI? This patient was witnessed by bystanders to collapse. They started CPR.

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Two 70 year olds with chest pain, and 3 pitfalls of the STEMI paradigm

Dr. Smith's ECG Blog

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?

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1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

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.

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A 50-something with chest pain.

Dr. Smith's ECG Blog

He reports that this chest pain feels different than prior chest pain when he had his STEMI/OMI, but is unable to further describe chest pain. VF was refractory to amiodarone, lidocaine, double-sequential defibrillation, esmolol, etc. Sensitivity was 87% for OMI in our validation study (it was 34% for STEMI criteria).

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50 yo with V fib has ROSC, then these 2 successive ECGs: what is the infarct artery?

Dr. Smith's ECG Blog

This certainly looks like an anterior STEMI (proximal LAD occlusion), with STE and hyperacute T-waves (HATW) in V2-V6 and I and aVL. How do you explain the anterior STEMI(+)OMI immediately after ROSC evolving into posterior OMI 30 minutes later? This caused a type 2 anterior STEMI. The April 8, 2022 post by Drs.

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Interventionalist at the Receiving Hospital: "No STEMI, no cath. I do not accept the transfer."

Dr. Smith's ECG Blog

Are Some Cardiologists Really Limited by Strict Adherence to STEMI millimeter criteria? He was found in ventricular fibrillation and defibrillated, then brought to a local ED which does not have a cath lab. This is the response he got: Interventionist: "No STEMI, no cath. It is a STEMI equivalent.

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What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. He required multiple defibrillations within a period of a few hours. There is no definite evidence of acute ischemia. (ie, This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation.