Category: Dr. Smith’s ECG Blog

Thrombus propagation on 10 serial Prehospital ECGs: Can you explain the progression?

This patient called 911 for chest pain.  The medics did an amazing job of recording serial ECGs. Time zero Hyperacute T-wave and subtle STE in aVL with Reciprocal ST depression (with reciprocally hyperacute T-waves!) in inferior leads.ST depression in V3-V6 typical of diffuse subendocardial ischemia. High lateral STEMI [typical of circumflex or first diagonal (D1) occlusion]? 

Two cases texted to me for concern of inferior hyperacute T waves and a flipped T in aVL – do either, neither, or both need emergent reperfusion?

Written by Pendell Meyers I received two texts recently, in both cases the practitioners were worried about possible inferior hyperacute T-waves with an inverted T-wave in aVL. I was not given any clinical history. What would you tell the team in these two cases? Case 1 Case 2 My responses: Case 1: “Not hyperacute. The

Timing of revascularization in patients with transient STEMI: a randomized clinical trial

European Heart Journal, ehy651, https://doi.org/10.1093/eurheartj/ehy651 Published: 26 October 2018 https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehy651/5145843?redirectedFrom=fulltext Timing of revascularization in patients with transient ST-segment elevation myocardial infarction: a randomized clinical trial. This study shows that for a transient STEMI (“complete normalization of ST segments”), it is not unequivocally necessary to activate the cath lab emergently.   This might extend to Wellens’ syndrome, which is

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR

Written by Pendell Meyers 84 yo M with history of a “valve problem” presented for sudden onset chest pain and trouble breathing while eating lunch.He was sitting bolt upright, diaphoretic, tachypneic, with bilateral crackles. Although his BP was 126/84, he was in acute cardiogenic shock.Here is his initial ECG: Sinus tach with occasional PACs. Relatively