Dr. Smith's ECG Blog

MARCH 7, 2019

Chest pain resolved, and a "Normal" ED ECG 2 cases of false pos STE aVL What will you do for this patient transferred to y. 30-something male with confusion, weakness, headac. A Patient with Respiratory Failure and a Computer. Cardiac arrest with STEMI pattern: no acute corona. How accurate are the Monitor leads for ST Elevation?

STEMI 52

STEMI Coronary CPR ACS 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

[link] Case continued She arrived in the ED and here is the first ED ECG. Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. Detailed coronary artery evaluation not performed.

Coronary 114

Coronary E-9-1-1 STEMI ACS 114

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The commonest causes of MINOCA include: atherosclerotic causes such as plaque rupture or erosion with spontaneous thrombolysis, and non-atherosclerotic causes such as coronary vasospasm (sometimes called variant angina or Prinzmetal's angina), coronary embolism or thrombosis, possibly microvascular dysfunction. This is not the case.

E-9-1-1 134

E-9-1-1 Coronary ACS BLS 134

Dr. Smith's ECG Blog

MAY 23, 2023

But the paramedic and the ED physician in this case did not subscribe to this idea. I have here 38 cases of "Computer Normal" ECGs which were critically abnormal and the vast majority are missed acute coronary occlusions (Missed Acute OMI) and most were recognized by the physician. So this study is worthless and must be ignored.

STEMI 98

STEMI Coronary Paramedic ED 98

EMS 12-Lead

APRIL 2, 2022

He reported a history of ischemic cardiomyopathy with coronary stent placement approximately 10 years prior, but could not recall the specific artery involved. Chou’s Electrocardiography in Clinical Practice, 6th ed. Goldberger’s Clinical Electrocardiography: A Simplified Approach, 9th ed. Attached is the first ECG.

ALS 130

ALS STEMI Coronary OR 130

Dr. Smith's ECG Blog

JUNE 18, 2013

I want all to know that, with the right mind preparation, and the use of the early repol/LAD occlusion formula, extremely subtle coronary occlusion can be detected prospectively, with no other information than the ECG. This was my thought: if this patient presented to the ED with chest pain, then this is an LAD occlusion. Asymmetric.

STEMI 52

STEMI Coronary ALS CAD 52

EMDocs

OCTOBER 30, 2023

” – Musings of an American ED resident in July 2022 when US healthcare was affected simultaneously by supply chain issues from GE Healthcare (contrast media) and Abbott Laboratories (Similac baby formula). 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013.

E-9-1-1 92

E-9-1-1 Emergency Department ALS ED 92

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Smith: If this is ACS (a big if), t his is just the time when one should NOT use "upstream" dual anti-platelet therapy ("upstream" means in the ED before angiography). Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease? J Electrocardiol 2013;46:240-8 2.

Coronary 52

Coronary ACS STEMI ALS 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

She arrived in the ED 37 minutes after 911 was called, with continuing CPR. Updates on the Electrocardiogram in Acute Coronary Syndromes. Current Emergency and Hospital Medicine Reports (2013) 1:4352. Electrocardiogram patterns in acute left main coronary artery occlusion. The patient was discharged neurologically intact.

Defibrillator 52

Defibrillator ACS CPR STEMI 52

REBEL EM

FEBRUARY 22, 2023

et al, Emergency Medicine Clinical Essentials ed 2. Philadelphia: Elsevier, 2013 (Ch) 26: p. Eye Emergencies, in Tintinalli J et al (eds): Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, Seventh Edition New York City: McGraw-Hill 2016 (Ch) 241 Guluma K, Lee JE. 209-225 Walker R, Adhikari S.:

Emergency Department 52

Emergency Department ALS ED Coronary 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

It is our job to identify this entity and ensure these patients receive the same care they would for a STEMI in any other coronary artery territory. Therein lies the limitation of electrocardiography in diagnosing acute coronary occlusion. Tips for recognizing Acute Posterior STEMI: 1. Neth Heart J. 2007; 15: 16-21. Wung SF, Drew BJ.

STEMI 52

STEMI E-9-1-1 Coronary ALS 52

REBEL EM

MARCH 22, 2023

Resources REBEL EM: SVT with Aberrancy Versus VT Amal Mattu’s ECG Case of the Week: August 26th, 2013 ALiEM: Tricks of the Trade: Valsalva Maneuver By Using a 10cc Syringe Larry Mellick: Treating SVT with Adensoine ALiEM: Trick of the Trade: Combining Adenosine with the Flush References Brugada P et al. Am J Emerg Med 2011; 29(5): 545-8.

ALS 52

ALS ED EMS Coronary 52

Dr. Smith's ECG Blog

APRIL 22, 2022

Int J Cardiol 2013 2. Identifying patients with low risk for acute coronary syndrome without troponin testing: validation of the HEAR score. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. Backus BE, Six AJ, Kelder JC, et al. Shin YS, Ahn S, Kim YJ.

E-9-1-1 52

E-9-1-1 STEMI ALS ED 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The patient was brought directly to the cardiac catheterization lab for PCI, bypassing the ED. The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. In the cath lab, the patient’s blood pressure remained low.

Coronary 40

Coronary ACS ALS STEMI 40

Dr. Smith's ECG Blog

JUNE 1, 2022

Moreover, the research which appears to confirm this idea was indeed in relation to the circumflex, but they did not study Occlusion ; rather, they studied asymptomatic coronary disease. I showed conclusively that this is a common finding in normal ECGs, though it is more common in LAD Occlusion than in norml variant STE.

STEMI 52

STEMI Coronary OR ALS 52

Dr. Smith's ECG Blog

JUNE 30, 2023

Along the way to acquiring more experience in recognizing the ECG findings of acute coronary occlusion — is incorporation of a number of KEY ECG Features into one's clinical acumen. Instead, the ST-T wave appearance may change in serial tracings recorded over the course of a single ED visit.

E-9-1-1 52

E-9-1-1 Coronary ED OR 52

Dr. Smith's ECG Blog

AUGUST 22, 2020

== MY Comment by K EN G RAUER, MD ( 8/22/2020 ): == The patient is a mid-50s man who presented to the ED for new-onset chest pain of ~1 hour duration. He was still having chest pain in the ED at the time ECG #1 was done ( Figure-1 ). The angiogram showed completely normal vessels ( No evidence of coronary disease! ).

Coronary 40

Coronary ED OR 40

Dr. Smith's ECG Blog

FEBRUARY 16, 2019

Posterior STEMI" may not even technically exist according to the current (2013) ACC/AHA STEMI guidelines, as it is not described as a "STEMI equivalent" and the only relevant statement in the guidelines is: "In addition, ST depression in 2 precordial leads (V1-V4) may indicate transmural posterior injury." Comment from K. What is "STEMI"?

STEMI 52

STEMI E-9-1-1 ACS OR 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" Smith and Meyers answer: First , LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.

Coronary 52

Coronary STEMI ACS ALS 52

Dr. Smith's ECG Blog

MAY 8, 2023

Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. I cannot be anything else.

STEMI 52

STEMI Coronary ED ALS 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

She was hypotensive in the ED and her bedside echo showed a normal RV and LV. Two prehospital 12-lead ECGs looked similar to this ED ECG: This shows diffuse ST depression (I, II, III, aVL, aVF, V3-V6) with reciprocal ST elevation in lead aVR. BP gradually rose. This ECG is diagnostic of diffuse subendocardial ischemia.

STEMI 52

STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

JULY 22, 2023

An ECG was performed in the ED at 1554: Original image unavailable, this is the only recorded scanned ECG available. QOH Interpretation: The initial troponin I (older generation) at the first ED was barely positive at 0.06 He denied chest pain or shortness of breath. See below for PM Cardio digitized version of this.

E-9-1-1 92

E-9-1-1 CAD STEMI OR 92

Dr. Smith's ECG Blog

NOVEMBER 24, 2017

Am J Cardiol 12(9):1379-1383; Nov 2013. Conclusion We might think about two reasons to be concerned with prolonged QT intervals in the ED. Still, absent data on how prevalent RR and QT pairs are in the ED, its hard to do better. Still, absent data on how prevalent RR and QT pairs are in the ED, its hard to do better.

ALS 52

ALS OR ED Coronary 52

Don't Forget the Bubbles

DECEMBER 5, 2023

Sex ed” sucks. A 2013 study found that half of young Australians are dissatisfied with school-based sex education. They believe that Sex Ed programs are irrelevant to real-life experience and contain inadequate discussion of important issues, including consent or positive sexual relationships. Why does it matter?

Coronary 109

Coronary Epinephrine CPR Emergency Department 109

ACEP Now

JUNE 14, 2024

Some of the critical differentials include pulmonary embolism, acute decompensated heart failure, pneumonia, pneumothorax, and acute coronary syndrome. Anginal chest pain, chest heaviness, or evidence of fluid overload suggest acute coronary syndrome or acute decompensated heart failure. Signs and symptoms of systemic infection (e.g.,

ALS 52

ALS Coronary ED OR 52

EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. of all patients in the ED for over 800 different stated indications. 5, 6 Further, any use of imaging prolongs ED stays, which by extension increases ED wait times for other patients.

E-9-1-1 100

E-9-1-1 ALS Emergency Department ED 100

Dr. Smith's ECG Blog

APRIL 13, 2025

He arrived in the ED and had this ECG recorded: The first high sensitivity troponin I returned undetectable (3 ng/L). Myocardial Infarction with Non-Obstructive Coronary Arteries. Etiologies (list not comprehensive): Coronary Spasm. The cath lab was activated by the medics. So this is "MINOCA". Embolism with lysis.

Coronary 93

Coronary STEMI EMS ALS 93

Dr. Smith's ECG Blog

MAY 15, 2025

The patient was accepted for emergent coronary angiography due to chest pain and ST-elevation. The coronary angiogram did not reveal any pathologic changes. Another ECG recorded after coronary angiography was unchanged from the initial tracing. High sensitivity troponin may increase slightly following coronary angiogram.

Coronary 79

Coronary CAD Overdose EMS 79

Dr. Smith's ECG Blog

APRIL 9, 2025

On arrival in the ED, a bedside ultrasound showed poor LV function (as predicted by the Queen of Hearts) with diffuse B-lines. Lidocaine had been used for the prevention of VF since the 1960s after coronary care units became a standard setting for the treatment of AMI. The paramedics diagnosis was "Possible Anterolateral STEMI."

Defibrillator 69

Defibrillator STEMI ED Coronary 69

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Rates of occurrence of PIRP have decreased drastically in the era of percutaneous coronary intervention. Incidence and Prognosis of Pericarditis After ST-Elevation Myocardial Infarction (from the Acute Coronary Syndrome Israeli Survey 2000 to 2013 Registry Database). of patients developed PIRP [ 1 ]. Oliva et al. [ Hammill, S.

STEMI 97

STEMI ALS OR Coronary 97