Are you treating myocardial infarctions? Why? That's DEAD tissue!

You should be treating myocardial ischemia!


What's the difference between ST elevation and ST depression?
Does ST depression ALWAYS represent a subendocardial ischemia?
Does ST elevation ALWAYS represent an acute transmural ischemia?
Which blood test do you use to confirm an acute transmural ischemia...
        ...troponins, or a CK-MB?

If you base you diagnosis of an acute transmural ischemia on the presence of ST elevation according to the STEMI protocol, then you are basing your diagnosis on a CK-MB, because that's the test that was used to "prove" that the ST deviation was or was not a STEMI! The STEMI protocol was based on just ONE article that used CK-MB assays as proof of acute transmural ischemia.

Is there a problem with that?

Well, no... if you don't mind missing about 25% of acute transmural ischemias that should have gone directly to the cath lab but instead were managed "medically!"

We often hear that someone can be having an acute transmural ischemia yet the ECG still looks normal. Is that really the case? ABSOLUTELY!

Well, that must mean the area at risk was very, very small... right? WRONG! Very large infarctions may not present with any ST elevation at all!

The STEMI protocol insists on ST elevation in two contiguous leads. Can an acute STEMI occur with ST elevation in only one lead in a vascular area? ABSOLUTELY!

Learn from a book filled with practical knowledge accumulated over almost 40 years of practice. If you feel that you can't learn anything from a book that doesn't have 8 or 9 footnotes per sentence, then this book is not for you. I have taken years of experience practicing internal medicine and emergency medicine combined with the information acquired from articles and books adhering to the highest standards of evidence-based medicine and combined everything into one book. The aim of this book is to make you a better clinician and a much better ECG interpreter. This is NOT the "only ECG book you will ever need" nor will it make you "an ECG expert in 3 days!"

Getting Acquainted With Ischemia and Infarction... Ischemia Is NOT an Infarction!

Available on Amazon and Barnes and Noble on-line.











Comments

Post a Comment

Popular posts from this blog

Image
  Analyzing an Acute MI “Jones’s Rule” and Primary Repolarization Changes Jerry W. Jones, MD FACEP FAAEM Figure 1 This is another 12-lead ECG randomly selected from my collection. There is a bit of baseline wander, but that’s life! It was recorded on a 68 y/o Hispanic female in the emergency department who was complaining of chest pain. There is no other information about her. First, the absolute basics. We can see by the upright P waves in leads I and II that sinus rhythm is present. The pos/neg biphasic P wave in Lead V1 is also supportive of sinus rhythm. The P wave in Lead V2 is basically isoelectric – but that’s OK, as long as it isn’t inverted or biphasic. There is 1:1 sinoatrial conduction and the P-R intervals are normal and remain the same. The rate is quite variable and may represent a sinus arrhythmia. Also, as we will see in a moment, there is also a good reason for increased parasympathetic influence on the rate. No apparent lethal dysrhythmias and no blocks are not...
Read more
Image
  Notes on a Randomly-Selected ECG Jerry W. Jones, MD FACEP FAAEM Figure 1 What is the rhythm on this ECG? Don’t be too quick to respond because I just asked you a trick question! Which rhythm are we discussing – the atrial rhythm or the ventricular rhythm ? Although this looks like a “single” ECG, it is really two ECGs – an atrial ECG and a ventricular ECG – one superimposed upon the other. Let’s begin with the atrial rhythm. Do you see any P waves? I don’t. That – by definition – is either atrial fibrillation , sinus arrest or third degree SA block . Now let’s consider the ventricular rhythm. It appears irregular . It is always best to assume that a ventricular rhythm that is based on an ectopic junctional or ventricular escape pacemaker will be very regular – even though it may be very slow. That isn’t always the case, but it will be about 99% of the time in my experience. OK… let’s put these two observations together: if the atrial rhythm (or lack of an atrial ...
Read more