ecg left-main-coronary-artery-occlusion-0 
EMDocs
DECEMBER 11, 2023
The most common diagnostic test to identify patients who might require percutaneous intervention is the electrocardiogram (ECG). Emergency physicians have recognized for some time that there are many occlusions of the coronary arteries that do not present with classic STEMI criteria on the ECG.
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?" Total LM occlusion can present with STE or STD in aVR. All are, however, clearly massive STEMI.
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Dr. Smith's ECG Blog
OCTOBER 28, 2022
Cortland Ashbrook from Spokane County, Washington, sent this message: Hey doctor Smith, I wondered if you’d give me your opinion on these ECG tracings I took as a paramedic in the field? Case: The call was an elderly gentleman who was at home when he experienced a sudden onset of vague chest discomfort along with nausea, and left arm aching.
Dr. Smith's ECG Blog
JANUARY 9, 2023
Meyers ECG Interpretation: Easily diagnostic of LAD occlusion. The ECG easily meets STEMI criteria in all leads V2-V6, as well. I sent this ECG to Dr. Smith, with the only information that it is a 17 year old with chest pain. The ECG was interpreted as "benign early repolarization."
Dr. Smith's ECG Blog
MAY 10, 2023
I do not have her previous ECGs, but reportedly these T-wave inversions were not present previously. However, when there is evolution of the T-waves, as with the 2nd ECG, the specificity for Wellens' is much higher. A CT Coronary angiogram was ordered. Here are the results: --Minimally obstructive coronary artery disease. --LAD
Dr. Smith's ECG Blog
MAY 30, 2023
His prehospital ECG was diagnostic of inferior posterior OMI. Here is his ED ECG: There is bradycardia with a junctional escape. We recorded an ECG in which V1-V3 were put in the position of V4R-V6R, and V4-6 were placed in V7-9 to (academically) confirm posterior OMI. Not all proximal RCA occlusion results in RV MI (i.e.,
Dr. Smith's ECG Blog
MAY 13, 2020
Here is the EMS ECG: Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVR Of course this pattern is most often seen from etoliogies other than ACS. The ECG only tells you there is ischemia, not the etiology of it. Angiogram: Severe diffuse left main disease, up to 80% at the ostial left main.
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