STEMI Archives - Emergency Medicine Cases

ECG Cases 54 The Art of Occlusion MI: Scale and Proportionality

On this month's ECG Cases, Dr. Jesse McLaren explains how STEMI criteria can be false positive with large scale QRS and proportional ST elevation, or false negative with low/normal scale QRS and disproportionate ST elevation and hyperacute T waves, and that rules for subtle occlusion using proportionality can help differentiate LBBB with or without Occlusion MI, or LV aneurysm vs anterior STEMI with Q waves... Please consider a donation to EM Cases to ensure continued Free Open Access Medical Education here: https://emergencymedicinecases.com/donation/

By Jesse McLaren|2025-02-17T12:26:20-05:00February 17th, 2025|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: Dr. Jesse McLaren, early repolarization, ECG, ECG interpretation, LBBB, LVH, occlusion MI, STEMI|0 Comments

ECG Cases 53 – The Art of Occlusion MI, part 1: Mirror Image

In this month's ECG Cases Jesse McLaren takes us through 6 cases highlighting important mirror concepts in ECG interpretation including: which leads are reciprocal to each other, how to identify which is the main ST/T change and which is the mirror, reciprocal changes highlighting subtle inferior, lateral and posterior OMI, ST elevation in aVR as a mirror to widespread ST depression and more...

By Jesse McLaren|2025-01-28T11:17:51-05:00December 3rd, 2024|Categories: Cardiology, ECG Cases, EM Cases|Tags: Dr. Jesse McLaren, ECG, ECG interpretation, mirror image, occlusion MI, reciprocal change, STEMI|4 Comments

EM Quick Hits 57 – HIV Diagnosis, Failed Paradigm of STEMI Criteria, Poisoned Patient Airway Management, Spontaneous Bacterial Peritonitis, DIY Investments

In this month's EM Quick Hits podcast: Megan Landes on the importance of diagnosing HIV in the ED, Jesse McLaren on the failed paradigm of STEMI criteria and ECG tips to identify acute coronary occlusion, Anand Swaminathan on evidence for non-invasive airway management in the poisoned patient, Brit Long and Hans Rosenberg on the identification, workup and management of spontaneous bacterial peritonitis, Matt Poyner on the most lucrative side-gig, DIY investing. To support EM Cases, please consider a donation here: https://emergencymedicinecases.com/donation/

By Shaila Gunn|2024-06-18T13:10:16-04:00June 18th, 2024|Categories: Cardiology, EM Cases, EM Quick Hits, Emergency Medicine, Gastroenterology, Medical Specialty, Resuscitation, Special Populations, Toxicology|Tags: ascites, cirrhosis, ECG interpretation, hiv, intubation, occlusion MI, paracentesis, spontaneous bacterial peritonitis, STEMI, toxicology|4 Comments

ECG Cases 50 – STEMI: A Failed Paradigm, Enter Occlusion MI

Dr. Jesse McLaren illustrates the paradigm shift from STEMI to Occlusion MI (OMI) through 9 cases, and drives home the points that if there is STEMI criteria, consider false positives (eg. secondary and proportional to LVH or BER); if there is no STEMI criteria, consider false negatives and look for other signs of occlusion (eg. acute Q waves or loss of R waves, hyperacute T waves, or reciprocal STD/TWI) and if the ECG is nondiagnostic, consider other OMI signs including clinical (refractory ischemia, hemodynamic/electrical instability) and POCUS (new regional wall motion abnormalities).

By Jesse McLaren|2024-06-18T12:07:45-04:00June 18th, 2024|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: Dr. Jesse McLaren, ECG, ECG interpretation, occlusion MI, STEMI|0 Comments

ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain

In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. They explain complementary diagnostic insights into pericardial effusion and cardiac tamponade, occlusion MI and RV strain...

By Jesse McLaren|2024-04-02T12:12:27-04:00April 2nd, 2024|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine, POCUS Cases|Tags: CHF, ECG, ECG interpretation, occlusion MI, pericardial effusion, POCUS, pulmonary embolism, RV strain, STEMI|0 Comments

ECG Cases 48 – ECG Interpretation in Cardiac Arrest

In this month's ECG Cases blog Dr. Jesse McLaren reviews interpretation of the pre-arrest ECG: identifying high risk ECGs requiring empiric treatment like calcium for hyperkalemia, magnesium for long QT, or reperfusion for Occlusion MI; the intra-arrest ECG: identifying pseudo-PEA; and post-arrest ECG: the importance of serial ECGs to reduce false positive STEMI, role of POCUS to help with the differential of diffuse ST depression with reciprocal ST elevation in aVR, and identifying signs of Occlusion MI/ false negative STEMI...

By Jesse McLaren|2024-02-13T11:44:22-05:00February 13th, 2024|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: cardiac arrest, ECG, ECG interpretation, hyperkalemia, occlusion MI, PE, STEMI, tamponade|0 Comments

ECG Cases 46 ECG in Fever and Infectious Disease

In this ECG Cases blog Dr. Jesse McLaren guides us through 10 cases, driving home the points that sepsis is a common cause of rapid Afib and diffuse ST depression with reciprocal ST elevation in aVR, myo/pericarditis is a diagnosis of exclusion, endocarditis or lyme carditis can cause AV block, PE can cause low grade fever and ECG signs of acute RV strain and that fever can unmask Brugada syndrome...

By Jesse McLaren|2023-12-20T15:43:15-05:00October 17th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: atrial fibrillation, Brugada, ECG, ECG interpretation, Fever, Lyme disease, occlusion MI, pericarditis, sepsis, STEMI|2 Comments

ECG Cases 44 ECG Interpretation in Epigastric pain, Vomiting

In this ECG Cases blog with Dr. Jesse McLaren we interpret 10 ECG cases and explore cardiac, metabolic and GI causes: We consider anginal equivalents, and look for ECG signs of Occlusion MI, including subacute occlusion from delayed presentations. We consider electrolyte disturbances and look for ECG signs of hyperkalemia or hypokalemia/hypomagnesemia, and we consider the differential of diffuse ST depression with reciprocal ST elevation in aVR, and false positive STEMI...

By Jesse McLaren|2023-08-08T22:28:20-04:00August 8th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: ECG, ECG interpretation, electrolyte, GI bleed, hyperkalemia, hypokalemia, occlusion MI, pancreatitis, STEMI|2 Comments

EM Quick Hits 50 Normal Unenhanced CT Renal Colic DDx, Perichondritis, Magnesium in Pediatric Asthma, Steroids for Pneumonia, OMI Cath Lab Activation

On this month's EM Quick Hits podcast David Carr on differential diagnosis of normal unenhanced CT renal colic, Leeor Sommer on recognition and management of perichondritis and auricular abscess, Suzanne Schuh on IV magnesium sulphate for pediatric asthma, Jess McLaren on Occlusion MI ECG interpretation requiring cath lab activation and Justin Morgenstern on update on steroids for pneumonia... Please support EM Cases with a donation: https://emergencymedicinecases.com/donation/

By Anton Helman|2024-09-27T20:30:30-04:00July 18th, 2023|Categories: Cardiology, Ears Nose & Throat, EM Quick Hits, Emergency Medicine, Genitourinary, Medical Specialty, Pediatrics, Respirology|Tags: ACS, atrial fibrillation, chest pain, community acquired pneumonia, ECG, hyperacute T wave, magnesium sulphate, occlusion MI, pediatric asthma, PRAM score, renal infarct, Sgarbosa criteria, STEMI, steroids|0 Comments

ECG Cases 43 – ECG Interpretation in Shortness of Breath

In this ECG Cases blog we look at 10 patients with shortness of breath, and discuss how the ECG can be used to help diagnose cardiac, respiratory and metabolic emergencies. We discover that for STEMI/OMI vs subendocardial ischemia, we should look for STEMI(-)OMI, subacute OMI, and OMI in the presence of LBBB and RBBB, and consider the differential for diffuse ST depression with reciprocal ST elevation in aVR. For RV strain, acute vs chronic, we should look for signs of acute RV strain and chronic pulmonary hypertension. for low voltages we should consider pericardial effusion and other causes, and for hyperkalemia we should look for multiple signs of hyperkalemia as a guide for empiric calcium...

By Jesse McLaren|2023-06-06T09:45:16-04:00June 6th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: cardiac tamponade, ECG, ECG interpretation, hyperkalemia, occlusion MI, pericardial effusion, pulmonary embolism, STEMI|0 Comments