Defibrillator, Events and STEMI

Guidelines would (erroneously) say that this patient who was defibrillated and resuscitated does not need emergent angiography

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

Defibrillator STEMI Coronary ALS

A 50-something with chest pain.

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

Defibrillator Coronary STEMI CPR

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

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

STEMI Paramedic Coronary ALS

Management of STEMI (ST-Elevation Acute Myocardial Infarction)

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

STEMI Coronary OR Defibrillator

Healthy 45-year-old with chest pain: early repolarization, pericarditis or injury?

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

OR STEMI ACS Coronary

See what happens when hyperacute T-waves are missed

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. One must always be careful when looking for "baseline" ECGs, because the prior ECG on file may have been during another ACS event, as this one clearly was. This ECG is highly suspicious for LAD OMI.

STEMI

STEMI Coronary ACS Defibrillator

Chest pain and a "normal" ECG

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

CPR Defibrillator STEMI ED

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

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

Emergency Department E-9-1-1 Coronary STEMI

Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

JANUARY 30, 2019

2) The STE in V1 and V2 has an R'-wave and downsloping ST segments, very atypical for STEMI. Cardiology was consulted and they agreed that the EKG had an atypical morphology for STEMI and did not activate the cath lab. Pediatric and elderly patients were more predisposed to developing an arrhythmic event in the setting of fever [7].

E-9-1-1

E-9-1-1 CAD STEMI OR

Chest pain, and Cardiology didn't take the hint from the ICD

Dr. Smith's ECG Blog

JANUARY 23, 2023

Back to the case: After the patient was roomed, he revealed that he had undergone several episodes of syncope in the last 24 hours with each event resulting in a shock during which his wife reported that he would immediately awaken. The most recent event had occurred just before being triaged.

ACS

ACS Coronary Defibrillator STEMI

A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?

Dr. Smith's ECG Blog

DECEMBER 5, 2019

If there are any syncopal or presyncopal events, she should be evaluated immediately in the ED. --All This article is on Brugada in general, not just fever-induced: A score model to predict risk of events in patients with Brugada Syndrome Here is full text: [link] This was a single center cohort of 400 patients with Brugada syndrome.

ALS

ALS OR Defibrillator STEMI

Acute coma, then Sudden PEA arrest in front of paramedics, with STEMI?

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Here is the written paramedic report available after all the events were over: Patient was seen by witnesses to become unresponsive. A 12-lead was recorded, showing "STEMI," but is unavailable. PEA is uncommon as an initial rhythm witnessed by EMS on the scene when the cause is an acute ischemic event.

STEMI

STEMI Paramedic E-9-1-1 Epinephrine

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Dr. Smith's ECG Blog

MARCH 8, 2025

Several 200 J shocks did not terminate the VF, so a second defibrillator was applied for double sequential defibrillation with 400 J. She was defibrillated perhaps 25 times. Propranolol versus Metoprolol for treatment of electrical storm in patients with implantable cardioverter-defibrillator. SanzRuiz, R., Solis, J., &

E-9-1-1

E-9-1-1 OR Defibrillator Coronary

Sometimes a patient is fortunate to have a cardiac arrest

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Unfortunately, the ECG was interpreted as no significant change from prior , "no STEMI"!! Defibrillation was performed, and ROSC was achieved. Approximately 5 minutes after ROSC, this ECG was obtained (about 45 minutes after arrival): Obvious anterolateral OMI, and STEMI criteria positive for those who care or need it.

STEMI

STEMI Defibrillator ACS OR

Recent MI at another facility. Now back in the ER with chest pain

Dr. Smith's ECG Blog

NOVEMBER 29, 2024

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. Throughout this process, the patient had repeated VF and was defibrillated 8 times. It is almost certainly not acute.

Defibrillator

Defibrillator STEMI Coronary ED

Paramedicine Now

Guidelines would (erroneously) say that this patient who was defibrillated and resuscitated does not need emergent angiography

A 50-something with chest pain.

Trending Sources

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

Management of STEMI (ST-Elevation Acute Myocardial Infarction)

Healthy 45-year-old with chest pain: early repolarization, pericarditis or injury?

See what happens when hyperacute T-waves are missed

Chest pain and a "normal" ECG

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Hyperthermia and ST Elevation

Chest pain, and Cardiology didn't take the hint from the ICD

A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?

Acute coma, then Sudden PEA arrest in front of paramedics, with STEMI?

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Sometimes a patient is fortunate to have a cardiac arrest

Recent MI at another facility. Now back in the ER with chest pain

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