Search Results for: anterior MI

Left ventricular aneurysm vs. acute anterior STEMI

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Some of you expressed concerns about the possibility of the ECG abnormality we sometimes refer to as left ventricular aneurysm (persistent ST-elevation after previous MI).

76 year old female CC: Chest pain – The case for this being an acute anterior STEMI

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As many of you pointed out, the history and clinical presentation isn’t exactly screaming “Acute Coronary Syndrome!”

Computer misses it, but the medic catches it.

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True fact: I failed out/dropped out of grad school in mathematics. But despite having little enthusiasm for topology or complex analysis, nothing drives me more nuts than people who say stuff like “I’m not good at math – just not a math person, I guess.” This attitude is not just incorrect, it’s harmful. Most mathematics […]

Anterior T wave inversions and PE.

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Last week, I described the case of a middle-aged male with a vague history of heart failure who had been having progressive shortness of breath for 4-5 days. On the day he called 911, he had been walking a short distance when he syncoped. EMS obtained an ECG: Compared with the prior ECG, the anterior […]

Conclusion: 53 YOF with AMS: STEMI or Secondary ST-T changes?

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This is the conclusion to the previous case: 53 YOF with AMS: STEMI or Secondary ST-T changes? This female presented to the ED with Altered Mental Status (AMS), via ambulance, as STEMI ALERT, after completing approximately 3 hours of her usual dialysis. This was the 12 lead ECG provided by EMS…   We have a […]

QRS AXIS DETERMINATION

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During ECG interpretation, cardiac Axis, or direction of electrical impulses, may be normal (physiologic) or abnormal (pathologic), suggesting abnormal cardiac conductivity. Although every deflection obtained on the ECG will have an axis, we will focus on the ventricular axis. When we think of our cardiac monitoring lead placement, we have to understand cardiac Vectors, which is the […]

RBBB Abnormalities Missed

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The original presentation of this case appeared as  "What's Wrong with Mr. Wilson?"… You can read the original post here. Much has been written lately about RBBB abnormalities that were missed.  Dr. Smith has recently posted two cases here, and here discussing this. First, let's review the 12 lead of a typical RBBB. When learning […]

AHA changes acceptable time to primary PCI from 90 to 120 minutes for acute STEMI

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Thanks to Ivan Rokos, M.D. for pointing out an important change in the 2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention. Photo credit: Code STEMI Web Series at First Responders Network For years now many have complained about the AHA's official recommendation that primary PCI for acute STEMI be accomplished within 90 minutes of first medical […]

Excessive discordance as a marker of acute STEMI in LBBB

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Positively deflected QRS complexes can be expected to show ST-depression and inverted T-waves.

Are all STEMI patients the same?

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When it comes to regionalized STEMI care, we treat all STEMI patients the same. But are they the same? The answer is, "No!" Most EMS protocols include a maximum ground transport time of 30-60 when bypassing non-PCI hospitals (AHA Mission: Lifeline calls them "STEMI Referral Hospitals"). The idea is that when the "first medical contact-to-balloon" […]

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
michelle
68 Year Old Male: Chest Tightness – Part 1
i see some depression and slight elevation in the st segment in the avr. i would alert the stemi crew to stand by.
2015-07-27 17:15:03
sean morrison
68 Year Old Male: Chest Tightness – Part 1
It's the big one Weezy! LAD
2015-07-27 12:48:03
Brooks Walsh MD
Computer misses it, but the medic catches it.
Well this blog is a great place to start! We cover most every aspect of emergency electrocardiography, with a variety of authors, and multiple perspectives, usually in a clinical context. If it is a book you are looking for, I prefer Ken Grauer's. I started with Dr Grauer as a paramedic student and I still…
2015-07-27 01:45:18
michelle
63 Year Old Female, CC: Neck and Arm Pain
looks like stemi . o2 , fluids, monitor and transport to nearest facility.
2015-07-26 16:24:04
The Six-Step Method for 12-Lead ECG Interpretation | EMS 12 Lead
Axis Determination – Part I
[…] 2.) Axis determination […]
2015-07-26 13:08:05

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