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MY Comment, by KEN GRAUER, MD (11/22/2024):
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— I'm not yet sure how to focus this?
— Could review LMain OMI (various ECG findings)
— Could put all 3 ECGs together — and comment on the progression (ie, with LMain occlusion, things really depend on WHEN during the course the cath is done
— Initial ECG shows 12/12 leads markedly abnormal (What were they thinking when they cancelled EMS request for cath lab activation?)
Figure-1: I've labeled the initial ECG in today's case. (To improve visualization — I've digitized the original ECG using PMcardio).
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| Figure-1: The initial ECG in today's case. (To improve visualization — I've digitized the original ECG using PMcardio). |
Hello Magnus. XXXXX. THANKS! — :)
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Written by SSmith (11/22/2024):
Hello Dr. Smith,
I attempted to have the receiving hospital activate the cath lab when I transmitted the initial ECG. Our transport time to the ED was 30 min. Unfortunately, the ED declined as it was viewed as an NSTE. I am still working to better identify OIM / NOIM and use the Queen of Hearts as a tool. In this case I was confident in my assessment of hyperacute T waves and STD for OMI and used QOH to confirm it. On your blog I appreciate the QOH ECGs that highlight where the QOH is looking. Thank you so much for your time and feedback on this case. I'll continue studying OMI / NOMI in ECGs and use the QOH to better provide patient care in the prehospital setting.
40 yo female with no known cardiac hx had acute onset chest pain, nausea, diaphoresis, weakness and husband called 911 to their Two Harbors home. Lake County Ambulance obtained ECG within 9 minutes and transmitted to ED. Serial ECG's obtained, none meeting true STEMI criteria, but dynamic changes noted. Pt transported to SMMC ED where Dr. Hansen and team obtained ECG now showing ST Elevation and alert activated. Pt transported to cath lab where Dr. Worden discovered multivessel disease and inserted an IABP. Pt had thrombotic nearly occlusive LM lesion with TIMI 1 flow in the LAD, Ramus, and Left Circumflex, and she was transferred for emergency CABG x 3. Etiology possible thromboembolic and less likely due to atherosclerosis or plaque rupture. Pt was extubated a day later and continues her recovery in the ICU. We are hopeful for her recovery. The STEMI alert to OR prep time for CABG was around 60 minutes and this exemplifies excellent, expedient teamwork. Thanks to all who cared for this patient!
Nick Hoffmann sent by Abby Thacher
Kind regards,
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