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What makes a T-wave Hyperacute? And: 30 Examples of Hyperacute T-waves, 10 in each of 3 myocardial territories.

Dr. Smith's ECG Blog

Doing so literally enables those of us who embrace the OMI Paradigm the ability to recognize within seconds that a patient with new CP ( C hest P ain ) — and — one or more hyperacute T waves — needs prompt cath regardless of potential absence of STEMI criteria. Figure-1: ECG from the August 26, 2009 post in Dr. Smith's ECG Blog.

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Prehospital Cath Lab Activation for inferior "STEMI" -- do you agree?

Dr. Smith's ECG Blog

Here is the prehospital ECG: The computer says STEMI Based on this and the presence of chest pain, the medics did a prehospital activation of the cath lab. A 40-something male complained of 3 days of chest pressure. He called 911. He had some pulmonary edema and hypoxia. What do you think? Interpretation: There is clear atrial flutter.

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Is this STEMI or NSTEMI? Neither. It is OMI.

Dr. Smith's ECG Blog

interesting spontaneous reperfusion case 1413140 prehospital STEMI first ED ECG is here, with 3/10 pain: But this is the same patient just 10 minutes before, with 7/10 pain Isn't it ridiculous to say that the patient has both a STEMI and an NSTEMI? ACS is dynamic. It can't be given one static name. Now the patient has one disease: OMI.

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OMI, NOMI, and EMS: The Case for EMS Recognition of Occlusive MI

NAEMSP

The subsequent diagnosis of an ST-segment elevation myocardial infarction (STEMI) sets forth a cascade of events that typically culminates in the patient being transported to hospital capable of emergent percutaneous coronary intervention (PCI). However, the notion of “STEMI equivalents” has gained traction.

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Chest pain and Bradycardia

Dr. Smith's ECG Blog

Diagnosis: Atrial Fibrillation with complete (3rd degree) AV block and inferoposterior STEMI. In the 1980's, it was believed that the right precordial ST depression that frequently accompanies inferior STEMI was due to "anterior subendocardial ischemia." Heart block in inferior STEMI is due to ischemia of the AV node.

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Another MUST know ECG, and why its notoriety annoys Dr. Smith

Dr. Smith's ECG Blog

This ECG pattern is my favorite example of how the STEMI criteria are fundamentally flawed. We have a series of 20 TIMI-0 LAD Occlusions that do meet STEMI criteria. 2020) If you are a regular reader of this blog this diagnosis will be easy for you, and you will manage this type of patient correctly with immediate revascularization.

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What can you find with continuous ST monitoring in the ED?

Dr. Smith's ECG Blog

The first EKG was concerning for a Wellen’s-like pattern of subtle reperfusion changes in the setting of stuttering anginal-equivalent symptoms, but none were diagnostic of STEMI or OMI. Later in the night, the patient became bradycardic and developed a Mobitz II pattern , but he remained asymptomatic and hemodynamically stable.

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