Dr. Smith's ECG Blog

JUNE 27, 2024

A patient had a cardiac arrest with ventricular fibrillation and was successfully defibrillated. COACT: The COACT trial was fatally flawed, and because of it, many cardiologists are convinced that if there are no STEMI criteria, the patient does not need to go to the cath lab. Lemkes JS, Janssens GN, van der Hoeven NW, et al.

Defibrillator 91

Defibrillator STEMI Coronary ALS 91

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

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).

Defibrillator 129

Defibrillator Coronary STEMI CPR 129

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

STEMI , ST-segment elevation acute myocardial infarction ). 1 Initial diagnosis of STEMI ECG Management Recommendation Level of evidence A 12-lead ECG should be interpreted immediately (within 10 minutes) at first medical contact. I B ECG monitoring should start immediately and a defibrillator must be ready.

STEMI 40

STEMI Coronary OR Defibrillator 40

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

Discharge ECG showed antero-inferior reperfusion T wave inversion: Had the initial ECG been signed off as “STEMI negative” the patient could have arrested in the waiting room, with a poor cardiac and neurological outcome.

OR 69

OR STEMI ACS Coronary 69

Dr. Smith's ECG Blog

OCTOBER 3, 2017

Side note: contemporary troponin drawn 1 hour after acute LAD occlusion should usually be negative, unless the event has been going on longer than the patients symptoms. After the second defibrillation the patient had an organized rhythm: Bradycardic escape/agonal rhythm, with large ST deviations.

CPR 52

CPR Defibrillator STEMI ED 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

She was defibrillated and resuscitated. Takotsubo is a sudden event, not one with crescendo angina. Even in patients whose moderate stenosis undergoes thrombosis, most angiograms show greater than 50% stenosis after the event. It is apparently fortunate that she had a cardiac arrest; otherwise, her ECG would have been ignored.

Emergency Department 52

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