Defibrillator, Information and STEMI

A man in his 50s with unwitnessed VF arrest, defibrillated to ROSC, and no STEMI criteria on post ROSC ECG. Should he get emergent angiogram?

Dr. Smith's ECG Blog

JULY 9, 2024

15 minutes after EMS arrival, after at least 6 defibrillations, the patient achieved sustained ROSC. Further information is not available. Despite anticipation by many that the initial post-resuscitation ECG will show an obvious acute infarction — this expected "STEMI picture" is often not seen.

Defibrillator

Defibrillator STEMI CPR EMS

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. I sent it to 5 of my OMI friends without any clinical information or outcome and all 5 independently responded with exactly the same diagnosis: "reperfused inferior OMI".

Defibrillator

Defibrillator Coronary STEMI CPR

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

Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. He required multiple defibrillations within a period of a few hours. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. The below ECG was recorded. What do you think?

Defibrillator

Defibrillator Coronary ALS STEMI

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

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

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

Are Some Cardiologists Really Limited by Strict Adherence to STEMI millimeter criteria? I was texted these ECGs by a recent residency graduate after they had all been recorded, along with the following clinical information: A 50-something with no cardiac history, but with h/o Diabetes, was doing physical work when he collapsed.

STEMI

STEMI Defibrillator ED ACS

Cardiac Arrest, acute ST elevation and depression superimposed on LVH, but NOT due to ACS

Dr. Smith's ECG Blog

OCTOBER 4, 2010

He was resuscitated with chest compressions and defibrillation and 1 mg of epinephrine. ACS would be highly unusual in a young athlete, and given the information on his race bib, one must first suspect that the abnormal ST elevation is due to demand ischemia, not ACS. This young male had ventricular fibrillation during a triathlon.

ACS

ACS Epinephrine Defibrillator STEMI

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. Remember that the ECG reports what is happening to the myocytes , then you must use that information to make inferences about what the patient needs. 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

I sent this ECG with no clinical information to Dr. Smith. 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. It should have been shocked at least 10 seconds ago.

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. Optical coherence tomography, due to its high resolution, may provide additional information [ 10,13 ]. STEMI MINOCA versus NSTEMI MINOCA STEMI occurs in the presence of transmural ischaemia due to transient or persistent complete occlusion of the infarct-related coronary artery.

Emergency Department

Emergency Department E-9-1-1 Coronary STEMI

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

Dr. Smith's ECG Blog

JANUARY 23, 2023

After reviewing the available information, cardiology did not feel that the patient warranted emergent PCI and recommended heparin infusion and cardiac catheterization the following morning. When the ICD was finally interrogated, the syncopal events and shocks correlated with two VF events that were defibrillated successfully.

ACS

ACS Coronary Defibrillator STEMI

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

OCTOBER 10, 2022

It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. I sent it to 2 of my ECG nerd colleagues with no clinical information whatsoever, who instantly said: "Looks like afib with subendocardial ischemia and right heart strain pattern." "I CPR was initiated immediately.

ACS

ACS CPR CAD Heart Attack

Cardiac Arrest, hypotension, tachycardia

Dr. Smith's ECG Blog

DECEMBER 22, 2010

After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. There is ST depression in II, III, and aVF that is concerning for reciprocal depression from high lateral STEMI in aVL, where there is some ST elevation. For more information, see chapter 28 of Smith's " The ECG in Acute MI." Plummer D et al.

STEMI

STEMI Epinephrine Defibrillator Emergency Department

Chest pain, among other symptoms. What do you see?

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

The computer called this Acute STEMI What do you think? STEMI never has a very short QT. There is Bazett, Fridericia, Hodges, Framingham and Rautaharju -- see here at mdcalc: [link] If the ST Elevation here were due to STEMI, it would be an LAD Occlusion. Treatment is by ICD ( implantable cardioverter defibrillator ).

STEMI

STEMI Defibrillator OR ED

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

Paramedicine Now

A man in his 50s with unwitnessed VF arrest, defibrillated to ROSC, and no STEMI criteria on post ROSC ECG. Should he get emergent angiogram?

A 50-something with chest pain.

Trending Sources

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

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

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

Cardiac Arrest, acute ST elevation and depression superimposed on LVH, but NOT due to ACS

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."

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

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Cardiac Arrest, hypotension, tachycardia

Chest pain, among other symptoms. What do you see?

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

Stay Connected