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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.

STEMI 59
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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.

STEMI 136
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Protocol Change

Peter Canning

For instance, there was no protocol for stroke or STEMI. At some point along the way we had protocols for spinal motion restriction, alcohol withdrawal, stroke and STEMI, CPAP, and termination of cardiac arrest resuscitation on scene. There were fewer than 50 protocols in the book, along with pages for 24 medications and 8 procedures.

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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.

EMS 69
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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.

STEMI 52
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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. However, many patients with de Winter ECG pattern have TIMI 0 at angiography and the ECG pattern does not necessarily progress to STEMI. 17 have HATW. Under Review.

STEMI 121
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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. Another EKG was also obtained. Very early in the morning, he reported recurrence of a heartburn sensation, so another EKG was obtained.

ED 116