Dr. Smith's ECG Blog

NOVEMBER 30, 2022

mm of ST segment elevation, V2 and V3 have 1 mm of elevation, v4 has 2 mm of elevation and v5 around 1.5 Takotsubo is a sudden event, not one with crescendo angina. Note 1: Levels were significantly lower in takotsubo that presented with T-wave inversion. Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al.

Emergency Department 52

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

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

For clarity — I’ve put these 2 tracings together in Figure-1. Figure-1: The initial ED ECG ( = E CG # 1) — with comparison to the patient’s baseline ECG done 4 years earlier ( = E CG # 3). The ECG finding that I KNOW is real in ECG #1 is the mirror - image appearance of ST-T waves in leads III and aVL.

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

Dr. Smith's ECG Blog

MAY 19, 2022

Anterior STEMI? Regarding the History: It sounds from the History as if this patient has at least a significant component of EIA ( E xercise- I nduced A sthma ). It also sounds from events described that he was unaware of this possibility. What is it? Activate the Cath Lab?

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E-9-1-1 Coronary ED OR 52

Dr. Smith's ECG Blog

OCTOBER 23, 2022

EMS recorded these prehospital ECGs: Time 0: In V2-V4, there is ST elevation that does not meet STEMI "criteria," of 1.5 If you use something like the HEART score: 1. E EKG: a negative ECG (score = 0) 3. Risk of 30-day adverse events is less than 1.7%. She was having a transient STEMI, briefly. Learning Points : 1.

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E-9-1-1 STEMI ED EMS 40

Dr. Smith's ECG Blog

DECEMBER 27, 2018

S-wave is in V2 = 17 mm S-wave V4 = 9 mm Total = 26 (not greater than 28), so not LVH by the new rule! But lead V2 has a worrisome amount of ST elevation, and in a chest pain patient, I would be worried about STEMI. For clarity — I’ve reproduced this ECG, to which I’ve made a few additions ( Figure-1 ). Peguero JG et al.

E-9-1-1 40

E-9-1-1 STEMI ALS OR 40

Dr. Smith's ECG Blog

JULY 12, 2020

I found a well appearing young lady in the room with her parents who witnessed the event. She denied having any symptoms before or after the event, and she was asymptomatic on my initial exam. She was diagnosed with pericarditis and spent one day in the hospital without events. mm STE depression in aVL.

E-9-1-1 40

E-9-1-1 ED STEMI OR 40

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." Case continued She was loaded with aspirin 325 mg, and repeat troponin drawn around the time of EKG 1 resulted at 267 ng/L. At midnight.

E-9-1-1 123

E-9-1-1 ACS Coronary STEMI 123

Dr. Smith's ECG Blog

JULY 22, 2023

A prior ECG from 1 month ago was available: The presentation ECG was interpreted as STEMI and the patient was transferred emergently to the nearest PCI center. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% per year incidence of SCD in this cohort [1].

E-9-1-1 92

E-9-1-1 CAD OR STEMI 92

Dr. Smith's ECG Blog

OCTOBER 24, 2018

A 40-something male presented with dyspnea and left arm numbness, and perhaps some chest tightness, for 1 1/2 hours. This is all but diagnostic of STEMI, probably due to wraparound LAD The cath lab was activated. E CG # 1 = the initial Triage ECG ( TOP ) — As per Dr. Why is this important? Thelin et al.

E-9-1-1 40

E-9-1-1 STEMI ACS Coronary 40

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Here they are: Learning Points: 1. 7 These 3 studies, as well as 1 smaller meta-analysis, 6 and another small study, 8 make it clear that troponin is associated with increased severity and mortality in COVID when adjusted for multiple other variables. 12 All STEMI patients had very high cTn typical of STEMI (cTnT > 1.0

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

OCTOBER 17, 2022

If you were thinking that this is not anterior OMI because there is no reciprocal ST depression , it is important to remember that half of anterior STEMI do NOT have any reciprocal ST depression. There are some unusual ECG findings in today's tracing ( that I labeled in Figure-1 ). Anterior OMI? Pericarditis?

E-9-1-1 52

E-9-1-1 STEMI OR 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

The pattern of STE and STD reminded us of Brugada Type 1 morphology. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. 2) The STE in V1 and V2 has an R'-wave and downsloping ST segments, very atypical for STEMI. per year incidence of SCD in this cohort [1]. Bicarb 20, Lactate 4.2,

E-9-1-1 52

E-9-1-1 CAD STEMI OR 52

Dr. Smith's ECG Blog

APRIL 3, 2019

Not quite a STEMI, but same effect.) There is ST elevation in V2-V4 that does not quite meet "STEMI criteria." That is a reasonable thought, but we have shown that if there is one lead of V1-V4 with a T/QRS ratio greater than 0.36, then it is STEMI, not LV aneurysm. Is this a transient STEMI? Learning Points: 1.

E-9-1-1 40

E-9-1-1 STEMI OR Coronary 40

Dr. Smith's ECG Blog

DECEMBER 29, 2024

The PMCardio Queen of Hearts app asks you, before giving an interpretation of OMI ("STEMI-Equivalent"), whether the patient's clinical presentation is high risk for OMI. Here are 9 cases that involve re-occlusion. If no, then she will tell you that the case is outside of the intended use group. In the November 27, 2024 post Drs.

E-9-1-1 66

E-9-1-1 STEMI Critical Care OR 66

Dr. Smith's ECG Blog

MARCH 3, 2025

The status of the patients chest pain at this time is unknown : EKG 1, 1300: There is sinus tachycardia and artifact of low and high frequency. Supply-demand mismatch can cause ST Elevation (Type 2 STEMI). Also see these posts of Type II STEMI. Also see these posts of Type II STEMI. An EKG was immediately recorded.

E-9-1-1 74

E-9-1-1 Coronary STEMI Emergency Department 74

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. Today's patient unfortunately developed PEA ( P ulseless E lectrical A ctivity ) arrest shortly after arrival of the medic team.

STEMI 89

STEMI Paramedic E-9-1-1 Epinephrine 89

Dr. Smith's ECG Blog

MARCH 8, 2025

1:45, case start To orient you to this screen, the top is obviously ECG waveforms. 1:51, diagnostic RCA angiography At this point, the patient very clearly has a diagnosis of OMI, especially since we visualized embolism within the PDA. & Falk, E. Papadopoulou, E., link] Falk, E., Bossone, E., Sharkey, S.,

E-9-1-1 75

E-9-1-1 OR Defibrillator Coronary 75