Dr. Smith's ECG Blog

JUNE 15, 2023

Here was his triage ECG: What do you think? I sent this ECG to the Queen of Hearts (PMcardio OMI), and here is the verdict: You can subscribe for news and early access (via participating in our studies) to the Queen of Hearts here: [link] queen-form Then I learned that a Code STEMI was activated for concern of anterior "STEMI" in V1-V2.

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Dr. Smith's ECG Blog

JULY 14, 2023

A 12-lead ECG was obtained: What do you think? had an initial hs-cTnI less than 52 ng/L (a level with a high PPV for Type 1 MI -- OMI or NOMI) Trops peaked at greater than 36,000 ng/L (very large MI of course) Post PCI ECG the next day: Looks like a nearly completed anterior MI, in spite of rapid reperfusion.

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Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Initial ED ECG: What do you think? Then we must consider clinical data other than the ECG, for a pretest probability : Of all wide complex tachydysrhythmias, the majority are VT. Formal bubble contrast echo showed EF 35% with anterior, anterolateral and inferolateral akinesis. Why did I say that?

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Dr. Smith's ECG Blog

JANUARY 23, 2023

Close up of V3 with baseline in red Close up of V4 with baseline in red This ECG alone is highly suspicious for posterior OMI! Cardiology reviewed the posterior ECG and once again concluded that as there was no ST elevation in the posterior leads, there was no need for emergent PCI. This is a very specific marker of posterior OMI.

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Dr. Smith's ECG Blog

JANUARY 12, 2023

Here are their ECGs: Patient 1: Patient 2: See below for "answers", and below that for both cases. Patient 2 has a normal variant ECG which mimics high lateral OMI, and ruled out for MI, see case below. ECG read as: "Shows T wave inversions in the inferior leads and less than 1mm STE in V2, without STEMI criteria."

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Dr. Smith's ECG Blog

JANUARY 28, 2023

This ECG is pathognomonic, regardless of any information, prior ECG, etc available: it means the LAD territory is undergoing immediate and hyperacute full thickness infarction, with the most likely etiology being type 1 ACS. Probably not the patient's "baseline" ECG, but it was the prior on file. The patient was transferred.

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Dr. Smith's ECG Blog

NOVEMBER 11, 2022

A 12 lead ECG was obtained by EMS and is shown below: What do you think? The ECG is diagnostic of LAD occlusion (or even left main occlusion possibly), with the classic pattern of RBBB and LAFB with huge concordant STE in V1-V2, I, and aVL, with reciprocal depression in most other leads (and/or a component of subendocardial ischemia pattern).

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EMDocs

JANUARY 20, 2024

ECG shows ST-segment elevation in V3-V6 only with depression in aVR. The most common findings on ECG are ST elevation , most often in the anterior precordial leads, as well as sinus tachycardia and QT interval prolongation. Initial vital signs include BP of 157/80, HR of 96, RR 14, SpO2 of 97% on RA, T 37.5.

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Dr. Smith's ECG Blog

MARCH 9, 2023

Here is his triage ECG at 0343: What do you think? Annals of Emergency Medicine Cardiology was called to evaluate the patient immediately for emergent cath, but they stated that the ECG did not meet STEMI criteria and elected to wait for further information before proceeding with cath. Vitals were within normal limits.

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Dr. Smith's ECG Blog

JUNE 2, 2023

She denied chest pain and denied feeling any palpitations, even during her triage ECG: What do you think? My bedside ultrasound was of insufficient quality, but showed somewhat reduced overall EF, distended IVC without respiratory variation, no pericardial effusion, and diffuse bilateral B lines. == What do you think of her ECG?

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Dr. Smith's ECG Blog

JANUARY 31, 2020

Here is his initial ECG: What do you think? I immediately looked for old charts, which were only available from another hospital, and an old echo confirmed inferior "akinesis" (which may also have persistent ST elevation). The patient's chest pain had resolved by the time of the ECG 2. There are well-formed Q-waves 3.

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Dr. Smith's ECG Blog

APRIL 12, 2013

Here is his prehosptial ECG: There are inferior Q-waves with ST elevation T-wave inversion. Here is his ED ECG: There is sinus tachycardia. The prehospital ECG is indeed alarming, and activating the cath lab is certainly not wrong. He had no chest pain. Medications were aspirin, clopidogrel, metoprolol, and simvastatin.

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Dr. Smith's ECG Blog

JULY 11, 2019

Here is the presenting ECG (no prior available): What do you think? Meyers : This ECG was texted to me with no clinical information, and my response was: "That looks like a very subtle LAD OMI. Sometimes serial ECGs minimizes the delay. ECG a few hours later: Some leads with STD previously have now resolved.

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Dr. Smith's ECG Blog

OCTOBER 26, 2011

QS-waves and depth of T-wave inversion are very helpful in determining the duration of injury (the "acuteness" of the ECG) , the viability of the myocardium, and patency of the infarct-related artery. Echo at this time showed some improvement in EF to 40%, but persistent akinesis and thrombus. The LAD has reperfused early.

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Dr. Smith's ECG Blog

AUGUST 28, 2020

I was texted these ECGs. This insistence on calling it lateral is due to a paper by Bayes de Luna -- [link] ] Case Continued I could only see the ECGs, not the echo. By the ECG, it is not necessarily subacute, but could be. ECG from 2 days later: Atrial Fibrillation now. The rhythm in ECG #1 is sinus at ~65-70/minute.

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Dr. Smith's ECG Blog

NOVEMBER 26, 2015

Here is her 12-Lead ECG: There’s a sinus rhythm at around 70 bpm. It is difficult to answer this question based on this single ECG alone. Although not always available a prior ECG is probably the most helpful piece of information in these cases. This was written by Sam Ghali ( @ EM_RESUS ), with a few edits by me.

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Dr. Smith's ECG Blog

JUNE 20, 2018

Paper published: Terminal QRS distortion not found in any ECG of Early Repolarization TQRSD is defined as the absence of BOTH an S-wave and a J-wave in leads V2 or V3. When I see this feature, the ECG represents LAD occlusion until proven otherwise. Another ECG was recorded: Is it true that there is "no significant change"?

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Dr. Smith's ECG Blog

NOVEMBER 10, 2008

Much of the time, there is only "akinesis", meaning no contraction of that territory. I cannot tell from this ECG if it is 12 hours or 12 years since the MI. But looking through the records, I found that he had an old anterior MI with anterior apical akinesis. This is an example of "old MI with persistent ST elevation".

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Dr. Smith's ECG Blog

MARCH 13, 2013

Here is a 15 lead ECG: Sinus rhythm. In my early repolarization/anterior STEMI study, I excluded any ECG with any precordial ST depression, considering this to be diagnostic of STEMI because normal variant precordial ST elevation does not coexist with simultaneous precordial ST depression. There is ST elevation in V1 (of 3.0

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