OMI or Subendocardial Ischemia (SEI)?
A 79-year-old woman with a history of hypertension and a benign brain tumor was awakened by chest pain and dyspnea. She reported having…
What happens when you give morphine for chest pain in ACS? And what is pseudo-normalization of T-waves?
Written by Magnus Nossen, with edits by Smith The patient in today’s case is a 70-year-old farmer. He has a history of coronary artery…
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…
Is There a Delayed Activation Wave???
This 50-something otherwise healthy male presented with one hour of epigastric and lower chest pain. Here is his initial ECG: What do you…
A middle-aged man with severe syncope, diffuse weakness
A middle-aged male diabetic who is otherwise healthy was found unconscious by his wife, with incontinence. He quickly awoke but was too…
Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. At midnight.
A middle aged male presented at midnight after 14 hours of constant, severe substernal chest pain, radiating to his throat and to bilateral…
Missed Acute MI, with coronary occlusion, evidence only by T-wave inversion in V2 and evolving ST depression in V3
A 39 yo otherwise healthy man with no risk factors was walking at the mall when he developed chest pressure. He presented to the ED…
Inferior STEMI: can we predict the infarct related artery?
Inferior STEMI may be due to RCA or circumflex occlusion (and occasionally due to a “Type III” or “wraparound” LAD,…
Cardiac Arrest suddenly after blood loss, is it due to MI? Also, when the rhythm looks like torsade, it is usually not.
A 74 yo f with ESRD on dialysis and h/o CAD bumped her access fistula and began to bleed profusely. She had a prehospital BP of 60, pulse 70,…
Inferior ST depression in ACS is reciprocal to ST elevation in aVL
For this topic, see also this post: https://drsmithsecgblog.com/2009/01/st-depression-limited-to-inferior-leads.html This 72 yo male with h/o…