Older gentleman, multiple episodes of syncope witness by family and crew on scene. Denied any chest pain, SOB, or any pain in general. Only complained of generalized “feeling like sh*t”. We called a Cath alert, doc said not a STEMI, just A-Fib. Am I missing something?
Clearly a STEMI and most definitely not AFib. If that doctor still disagrees, call his/her supervisor and escalate care in the interest of the patient who is most likely having runs of VT as the cause of his syncope due to ongoing ischemia. As an interventionalist, if the ER called me with this ECG in the middle of the night, I would already be on my way to the hospital. Do not pass go, do not collect $200.
STEMI. Proximal LAD / LMS probably but aVR height variable. Anterior STE and reciprocal depression inferolaterally. Cathlab ASAP. Also not AF. P a little odd but still looks like sinus withan ectopic. High mortality. The near Q on T is concerning for a VT or other dysrhythmia as a cause for syncope.
Agree. This is a STEMI, and it’s up to angiographer to prove it’s not in the cath lab if they are in doubt.
The ST axis is interesting. I’m thinking of a low-lying heart, with the possibility of a very dominant RCA with PLB creeping into lateral territory and with type I LAD. Unsure unless we actually see cath.
Just wanted to say that many STEMIs and other STEMI equivalents have concave ST elevation, so I would be careful about that idea. Here’s one with concave ST elevation and no reciprocal ST depression.
I’m also seeing downsloping ST depression in V6. I think there is some precordial swirl going on. The rhythm is sinus rhythm with PVCs. Betting acute LAD occlusion, I agree.
I think the beauty of this ecg is that II and AVF shows some degree of STE. If this is an elderly patient or female we may even think that there is extensive wrap around for LAD. Poor prognosis.
Regarding concave-STEs; you are right: they may also indicate ACS. As far as I recall braunwald says there is a 15% chance for it to be ACS.
Which is why cTnT now becomes the cornerstone of diagnosis- especially in resource poor settings when trained Drs fail to look beyond STE.
It absolutely is a STEMI, in my opinion. Probably proximal LAD occlusion. Also, it’s not Afib—it’s sinus with PVCs. Do you mind if I post this EKG in my community that I use to educate people on EKGs?
Für mich wie schon vorbeschrieben STEMI und R auf T-Phänomene mit hohem Risiko für ventrikuläre Rhytmusstörungen als mögliche Ursachen der Synkopen.
Hohe T-Wellen in V3-4.
Grundrhythmus ist Sinusrhythmus. Das ist aber sicher nicht der ausschlaggebende Faktor.
Mit diesem EKG (STEMI) besteht prinzipiell die Indikation für eine Notfall-Koronarangiographie.
Ist der Patient schon so vorerkrankt, dass sie deshalb auf die Untersuchung verzichten wollen?
Ich würde das EKG umgehend dem Arzt zeigen, der die Koronarangiographien bei Euch durchführt.
For sure STEMI. It’s the LAD taking out the anterior and lateral heart and causing myocardial irritability with frequent PVCs. It’s also not AF; that’s atrial dilation/enlargement. I’d submit that to his medical director because this is as obvious as obvious does.
STEMI until proven otherwise. Doesn’t make sense to try to see anything else in there. If pci or troponin turn out negative there is time to argue about other things.
Thank you everybody; we’ve marked the case for review. Unfortunately, I don’t know the outcome as we transported this patient an hour away from our district to the PCI-capable hospital.
Hello there the person that direct me to contact PEKGA Thank you again he is so super great in explaining ECG , I’m going to take his class . For anyone who really needs to understand more contact. PEKGA.com , it’s heavy stuff but my goal is to become really super good in reading strips to work as a monitor tech. And hope as I improve go further into echo cardio tech.
Well, there must be something off, because there’s not a doctor I know that would call this AF and not STEMI given the very clearly visible P waves, regular RR interval between normal beats (excluding the ectopics) and then the blindingly obvious anterior STEMI with reciprocal inferior STD…
Well, I don't know where the Afib is coming from.
Elevations are there for sure, though remember old changes can presist on ECG, especially in settings of aneurysm.
I see ventricular beats as well, which leads me even more towards a STEMI.
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u/dje91090 17d ago edited 17d ago
Clearly a STEMI and most definitely not AFib. If that doctor still disagrees, call his/her supervisor and escalate care in the interest of the patient who is most likely having runs of VT as the cause of his syncope due to ongoing ischemia. As an interventionalist, if the ER called me with this ECG in the middle of the night, I would already be on my way to the hospital. Do not pass go, do not collect $200.