Discover and read the best of Twitter Threads about #STEMI

Most recents (6)

Here’s a great #ECG of a man who presented to the ER with crushing chest pain.

[thread] Image
Here’s the ECG Computer Read:

"Non-specific ST abnormality, consider anterior subendocardial ischemia."

Take a good look at Leads V1-V3 and burn these morphologies and this pattern into your mind.

THIS is what Posterior #STEMI looks like on a Standard 12-Lead ECG!

[3/x] Image
Read 11 tweets
Lots of talk about the expected surge in ICU and hosp beds with #COVID. I’ve been hearing about reducing elective case burden (great thread from @ajaykirtane about that). We should also be rethinking our hospital approach to conditions that will continue in the covid era 1/n
Most obvious is with #STEMI care. If your hospital doesn’t have an ED bypass protocol for stemis - probably a good time to develop one. Ours at @VHC_Hospital has 1 min pitstop in ed w ems txp to cath lab - less pt exposure time to ED and less burden on ED resources 2/n
Also with #STEMI care - No icu for stable pts w normal EF should be standard. For most of these pts ICU is not necc and creates unneeded exposure for pt and occupies much needed ICU beds. (I think @agtruesdell had a great thread on this a while back) 3/n
Read 11 tweets

9⃣1⃣1⃣ #STEMI 🚨 example
➕ST elevation 3>2
➕Right sided leads (shown): ST elevation in V4R-V6R leads
=Inferior MI with RV involvement

⚠️ caution with nitroglycerin in this patient
👉 Preload dependent
🛑⇪Vagal tone may lead to heart block

A nice algorithm when confronted with inferior STEMI
Full right sided 12 lead ECG

Read 4 tweets
Recently in our #MICU, I took pics of the oxygen sats of patients on oxygen supplementation.

What is the optimal oxygen supplementation strategy for a clinically stable patient in the ICU?

Follow me down this #tweetorial rabbit hole. #medtwitter #pulmcc #AIMW19
Given that population health improvements often come from small benefits in large populations, and the fact that #oxygen is one of the most commonly prescribed interventions in the #ICU, there is potential for benefit if we can correctly titrate our oxygen titration.
I’m going to refer to hypoxia and hyperoxia in this #medthread, and I’d like to (somewhat arbitrarily) define these terms. I’ll call hypoxia anything below 90% and hyperoxia anything above 96%. This is based upon some of the literature I will discuss.
Read 23 tweets
Study warns against combined use of oral #anticoagulants , #antiplatelet therapy for #AFib 1️⃣

#GARFIELD-AF registry…
2️⃣ Currently, do you stop #aspirin w #NOAC #DOAC for #AFIB in pts w previous history of stent (>1yr prior) for non-ACS CAD ? (Yes- I know it should be a less and less common scenario)
3️⃣ Currently, do you stop #aspirin w #NOAC #DOAC for #AFIB in pts w previous history of CAD ( #STEMI / #NSTE-ACS >1year prior) ?
Read 3 tweets
Intro/10 #STEMI #tweetorial #FITSurvivalGuide for #ACCFIT. Organized by @dr_chirumamilla. @ACCCardioEd @ACCinTouch
1/10 #STEMI from ruptured plaque, less plaque erosion. @BraunwaldEugene pic demonstrates LDL oxidized, glycated➡️cytokines release express adhesion molecules➡️monocytes roll, diapedesis➡️ingest LDL, become foam cell➡️SMC migrate, proliferate➡️some apoptosis➡️plaque Image
2/10 Why #STEMI on #ECG
1. Diastolic current of injury: current away from relatively depolarized injury➡️TQ depression➡️normalized on ECG➡️ST elevation
2. Systolic current of injury: current towards injury due to early repol➡️ST elevation Image
Read 19 tweets

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