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Time is Brain

Peter Canning

In 2014, we became an official stroke hospital, which meant we were now meeting rigid standards of care set by the American Heart Association. It wasn’t long before we started doing thrombectomies, a procedure similar to what is done for heart attack patients. About the same time we started to host the annual stroke symposium.

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SGEM#421: I Think I’d Have a Heart Attack – Maybe Not in a Rural Area?

The Skeptics' Guide to EM

Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. She is the cofounder of FOAMcast and a […] The post SGEM#421: I Think I’d Have a Heart Attack – Maybe Not in a Rural Area? Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI.

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Circumflex Occlusion May be Subtle or Invisible on the ECG

Dr. Smith's ECG Blog

male presents because he "thought he might be having a heart attack." First, this patient had a known stent in the "marginal" artery and thought he was having a heart attack. By definition, this is a non-STEMI because there is not 1 mm of ST elevation in 2 consecutive leads. How can you make the diagnosis?

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A man in his 70s with chest pain

Dr. Smith's ECG Blog

He stated it was similar to prior heart attacks. Both hyperacute T waves and posterior OMI are now formally endorsed as "STEMI equivalents" by the ACC. == MY Comment, by K EN G RAUER, MD ( 11/23 /2022 ): == Cases in which initial ECG findings are subtle before undergoing dramatic change, — are always impressive.

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Early repol or anterior OMI?

Dr. Smith's ECG Blog

He noted that his father died from a heart attack in his early 50s prompting his presentation to the emergency department. This ECG is highly concerning for LAD occlusion despite it not showing a STEMI criteria. Here is the initial ECG at 13:17 with no prior ECG in the patient’s chart for comparison: What do you think?

OR 127
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46 year old with chest pain develops a wide complex rhythm -- see many examples

Dr. Smith's ECG Blog

He reported a history of “Wolf-Parkinson-White” and “heart attack” but said neither had been treated. The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI. Is there STEMI? These diagnoses were not found in his medical records nor even a baseline ECG. What is the rhythm?

STEMI 114
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A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Dr. Smith's ECG Blog

50% of LAD STEMIs do not have reciprocal findings in inferior leads, and many LAD OMIs instead have STE and/or HATWs in inferior leads instead. The ECG easily meets STEMI criteria in all leads V2-V6, as well. 24 yo woman with chest pain: Is this STEMI? This is not "diffuse", this is simply anterior, lateral, and likely apical.