Webinar: Beyond STEMI: Diagnosing Acute Coronary Occlusion on the ECG. The Queen of Hearts can do it for you!!
Beyond STEMI: Diagnosing Acute Coronary Occlusion on the ECG. The Queen of Hearts AI app can do it for you. With explainability too. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - December 5, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Quiz post: 2 similar patients with similar ECGs. Which, if any, or both, are OMI? Will you outperform the Queen of Hearts?
Written by Pendell MeyersTwo adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both were awake and alert with normal vital signs. Both cases had an EMS ECG that was transmitted to the ED physician asking " should we activate the cath lab? "What do you think? Here they are:Patient 1, ECG1:Zoll computer algorithm stated: " ***STEMI***, Anterior Infarct "Patient 2, ECG1:Zoll computer algorithm stated: " ST elevation, probably benign early repolarization... "Queen of hearts interpretations:Patient 1, ECG1:Patient 2, ECG1:Patient 1 Clinical Course and Outcome:The EM physician d...
Source: Dr. Smith's ECG Blog - November 29, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Chest pain and new regional/reciprocal ECG changes compared to previous ECGs: code STEMI?
Written by Jesse McLaren A 45 year old presented with two weeks of recurring
non-exertional chest pain, now constant for an hour. Below is old and then new
ECG (old on top; new below). What do you think?Both ECGs have normal sinus rhythm, normal conduction and
normal voltages. There ’s a change in axis that may interfere with direct
lead-to-lead comparison, but there appear to be larger T waves in I/aVL and new
TWI in III/aVF. But do they represent acute coronary occlusion? Because of the ECG changes in a patient with chest pain, and
with inferolateral hypokinesis on POCUS, the cath lab was activated. But...
Source: Dr. Smith's ECG Blog - November 27, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Infection and DKA, then sudden dyspnea while in the ED
To learn more about Occlusion MI, join us in thisFree Webinar on November 27 12 noon US Central Time:Sign up at this link: https://zoom.us/webinar/register/2216945975176/WN_7HuMRHNxREKifGgQvy70lg#/registrationInfection and DKA, then sudden dyspnea while in the EDA 63 year old male with a PMH of CAD and peripheral vascular disease from type 1 DM presented to clinic and was found to have a very high blood sugar and so was sent to the emergency department.Patient stated that he has had glucose over 400 even though he has not missed any doses of insulin. He also endorses fatigue, upset stomach, frequent urination, i...
Source: Dr. Smith's ECG Blog - November 22, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Acute Dyspnea and Right Bundle Branch Block
I was texted this ECG just as I was getting into bed.It is of an elderly woman who complained of shortness of breath and had a recent stent placed.I was told that the Queen of Hearts had called it OMI with high confidence.What do you think? Ken (below) is appropriately worried about pulmonary embolism from the ECG. What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema.Here is my interpretation:There is sinus rhythm with RBBB. If you jump to looking at ST segments, you see " coved " ST in V3, V4, V5, with subtle ST Elevation. This is HIGHLY ...
Source: Dr. Smith's ECG Blog - November 18, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?
A 70-something female with no previous cardiac history presented with acute chest pain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest. She said this was midsternal and felt like a tightness. This originally radiated into her left arm. Over some time and the pain moved into her other arm as well as her jaw. She also had some shortness of breath. She was brought in by ambulance and re...
Source: Dr. Smith's ECG Blog - November 15, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
How important are old ECGs in Non-obvious cases of potential OMI?
Conclusion: As per Dr. Smith — the cath lab was initially activated on the basis of the history of changing symptoms occurring in association with dynamic ST-T wave changes on these 3 serial ECGs shown in Figure-1.BUT — Review of this patient ' s medical chart revealed previous ECGs showing a similar pattern of labile ECG changes. Some patients do this ... that is, show a pattern of labile ST-T wave changes not due to an acute coronary event.Despite the seemingly worrisome ST-T wave changes on serial tracings shown in Figure-1 — an acute event was definitively ruled out b...
Source: Dr. Smith's ECG Blog - November 14, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 90-something with acute stroke. She has no chest symptoms. What is the diagnosis?
A 90-something year old woman presented with an acute mild stroke.She had a routine ECG as part of her workup:What do you think?This was shown to me in real time.I thought it had to be an inferior-lateral-posterior OMI. But the patient had no symptoms. Later, she did admit to some vague chest discomfort, but that could be due to the power of suggestion.The one strange thing that I noted at the time is that there is no reciprocal ST depression in aVL. This is extremely unusual in inferior OMI, even if there is simultaneous STE in V5-6.We studied this: In this paper on the importance of lead aVL f...
Source: Dr. Smith's ECG Blog - November 11, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Explain this ECG in the context of active chest pain, slightly elevated troponin without a delta, RCA culprit, and previous with LBBB
A 60-something yo female presented w/ exertional chest pain for 3 days. She had a recent positive stress test about one week ago. Pain was 8/10 and constant. She has been experiencing progressively worsening exertional dyspnea and chest tightness mostly when climbing up flights of stairs since early September. She underwent exercise echocardiogram in mid October where she exercised for nearly 7 minutes on the standard Bruce protocol and had typical anginal pain and shortness of breath. Baseline echocardiogram showed moderate LV systolic dysfunction with no wall motion abnormalities. Over the last...
Source: Dr. Smith's ECG Blog - November 9, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Wide complex and apparent hyperacute T-waves. Does absence of change from previous ECG mean that it is not New?
By Magnus Nossen, edits by Grauer and SmithThe patient is a 70-something female with DMII, HTN and an extensive prior history of coronary artery disease and myocardial infarctions. She ' s had multiple PCI procedures. She also has sick sinus syndrome (SSS) and intermittent high grade AV block for which she had a dual chamber pacemaker implanted. On the day of presentation she complained of typical chest pain, and stated it feels like prior MI. Just from the medical hx and clinical presentation this patient is very likely to be having an MI. The question is, does she need to go urgently to the cath lab or can she wait....
Source: Dr. Smith's ECG Blog - November 5, 2023 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
See this " NSTEMI " go unrecognized for what it really is, how it progresses, and what happens
Written by Nathanael Franks MD, reviewed by Meyers, Smith, Grauer, etc.A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. This episode of chest pain began 3 hours ago and was persistent even at rest.Triage ECG at Time = 0: Smith: I am suspicious for posterior OMI due to ST depression in V2 and V3Baseline EKG (several months prior):Smith: Now I am even more suspicious of posterior OMI, as the baseline ECG has normal ST elevation in V2 and V3ECG Interpretation:The tri...
Source: Dr. Smith's ECG Blog - November 3, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
What do you think of this ECG that was texted to me?
This ECG was texted to me by a colleague. I assumed it was from a patient with symptoms compatible with ACS/OMI.What do you think?There is sinus rhythm with RBBB and ST Elevation in V2 which is concordant with the QRS. The ST segment in RBBB should be ST depression, discordant to the positive R ' -wave (i.e., opposite direction of the upright R ' -wave). But we sometimes see this concordant STE even in non-ischemic ECGs:PseudoSTEMI and True ST elevation in Right Bundle Branch Block (RBBB). Don ' t miss case 4 at the bottom.This STE suggests OMI, but we have seen many cases like this th...
Source: Dr. Smith's ECG Blog - November 1, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
" Non-STEMI " is a worthless term.
A 60 yo with 2 previous inferior (RCA) STEMIs, stented, called 911 for one hour of chest pain. He had no h/o heart failure. Here is the first prehospital ECG (time 0, after one hour of pain): I do not see evidence of OMI, and neither did the Queen of HeartsHere is the 2nd prehospital ECG (time 10 minutes, after 70 minutes of pain): No changeOn arrival, the first ED ECG was recorded 20 minutes after the last one (90 minutes after pain onset): What do you think?Here is his most recent previous ECG:This was recorded after intervention for inferior STEMI (with massive ST Elevation, see below), and shows inf...
Source: Dr. Smith's ECG Blog - October 30, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Continuous prolonged generalized weakness, lightheadedness, and presyncope. What might you suspect from the ECG?
A young man presented with continuous prolonged generalized weakness, lightheadedness, and presyncope. There was some dyspnea but no chest pain. Here is his ECG. This shows LVH, with high voltage.LVH can have very thick-walled ventricles and a correspondingly small LV cavity. LVH is a common etiology of heart failure with preserved ejection fraction, as it may results in a stiff ventricle with poor diastolic relaxation.See this articles: Heart Failure with Preserved Ejection Fraction (NEJM review)One etiology of LVH on the ECG is Hypertrophic Cardiolmyopathy (HOCM), and sometimes ECGs in pa...
Source: Dr. Smith's ECG Blog - October 28, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Making Waves from Mayo clinic: Artificial Intelligence-Augmented ECG Interpretation Using Smartphone Technology with Anthony Kashou and Robert Herman
@RobertHermanMD on Making Waves from Mayo clinic.Artificial Intelligence-Augmented ECG Interpretation Using Smartphone Technology@TheEKGGuyhttps://www.youtube.com/watch?v=MHRtaRqXr_k (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - October 26, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
