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!”

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" […]

Right ventricular hypertrophy vs. isolated posterior STEMI

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A reader of the Prehospital 12-Lead ECG blog asks, “How can you tell the difference (based on ECG criteria alone) between right ventricular hypertrophy and acute isolated posterior STEMI?” Well, the good news is you don’t have to tell “based on ECG criteria alone” and I’m sure all of my regular readers know that I […]

Left anterior fascicular block (LAFB)

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A reader by the name of Jesse contacted me and wrote: I have a question. I’m trying to learn more about fasicular and hemi blocks. I was curious if you have posted, or intend to post, any information regarding these. I understand this is all done on your free time, so no rush at all. […]

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Brian
83 Year Old Male: Shortness of Breath
I mostly agree with dustin. I believe this is may be an isolated posterior MI. The R wave in V2 points to it being a posterior MI. otherwise it is a 1st degree av block with a LAHB. I am somewhat concerned with the concordant t segment depression noted and in fact if you were…
2014-10-30 04:22:44
Karl Brennan
Understanding Amiodarone
Great article , however in VF caused by hyperkalemia it should be avoided along with lidocaine , Since it shuts down the K channels, the eiteiology of the arrest hyper K, K channels are needed to exchange K in the cell. Calcium , Bicarbonate, dextrose and insulin should be used to decrease K levels along…
2014-10-30 03:04:45
Dustin
83 Year Old Male: Shortness of Breath
I see a very sick and complicated patient. 12 Lead: ST elevation in AVR and V1 along with depression in I, II, V4-V6 leading me to an LMCA occlusion. The tall R wave in V2 also points me to Posterior involvement. Posterior MIs and LMCA occlusions can and do cause pulmonary edema, which this patient…
2014-10-30 02:38:21
Adrian
83 Year Old Male: Shortness of Breath
Firstly, the patient is septic, he needs high flow O2 (which he's already receiving), IV fluids, blood cultures and antibiotics (most likely IV) and needs to be in resus sharpish. Secondly, the ECG needs doing again, V2 is wrong and I'm not sure where it's been placed to get that reading. Assuming the rest of…
2014-10-30 01:00:42
Ken Grauer, MD
83 Year Old Male: Shortness of Breath
I see a regular rhythm at ~ 95/minute with LOTS of baseline artifact. I am not certain if there are P waves or not ..... It does look in leads V3,V4 like there are P waves with a long PR interval - but I cannot be certain in lead II that there is an upright…
2014-10-30 00:59:40

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