Spoon Feed
In non-ischemic right bundle branch block (RBBB) ECGs, we expect discordant ST depression and T wave inversions in leads V1-V3. ST segment elevation, or even an isoelectric ST segment, in these leads is abnormal and should make us concerned for ischemia. See below.
Spoon Feed
A recalibrated HEART score ≤ 3 utilizing hs-cTnT ruled out MACE (adjudicated type 1 MI, unplanned coronary revascularization, and all cause death) at 30 days at a sensitivity of 98.5% and NPV of 99.7% with the ability to discharge 46.5% of patients in this cohort.
Source
HEART Score Recalibration Using Higher Sensitivity Troponin T. Annals of emergency medicine, S0196-0644(23)00313-X. 10 Jun. 2023, doi:10.1016/j.annemergmed.2023.04.024
Spoon Feed
Analysis of multiple prior RCTs finds direct oral anticoagulants (DOAC) have improved safety and efficacy vs. warfarin in atrial fibrillation (AF) even as renal function decreases to as low as 25 mL/min.
Source
Direct Oral Anticoagulants Versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses From COMBINE AF. Circulation. 2023 Jun 6;147(23):1748-1757. doi: 10.1161/CIRCULATIONAHA.122.062752. Epub 2023 Apr 12.
Spoon Feed
Presented is a discussion of ECG and clinical findings in the setting of a ventricular paced rhythm (and other wide QRS complex rhythms) that could signal the presence of occlusion myocardial infarction (OMI).
Spoon Feed
In patients with ROSC after OHCA, these ‘STEMI equivalents’ do not appear to accurately diagnose ACS based on this study.
Spoon Feed
Previous guidelines suggested that isolated aVR elevation with multi-lead ST depression could be considered as a STEMI equivalent. However, current evidence suggests aVR elevation is not specific for an acute coronary event.
Source
Does ST Elevation in Lead aVR Require an Emergent Trip to the Catheterization Laboratory? JAMA Intern Med. 2023 Mar 1;183(3):261-262. doi: 10.1001/jamainternmed.2022.5901.
Spoon Feed
Hyperacute T-waves are best conceptualized as being tall and wide relative to the size of the QRS complex, as well as abnormally symmetric, and can be used to aid in early identification of an acute coronary occlusion.
Source
Hyperacute T-waves Can Be a Useful Sign of Occlusion Myocardial Infarction if Appropriately Defined. Ann Emerg Med. 2023 Mar 3:S0196-0644(23)00025-2. doi: 10.1016/j.annemergmed.2023.01.011. Epub ahead of print.
Spoon Feed
In this secondary analysis of the ALPS trial (Amiodarone, Lidocaine, or Placebo Study), researchers found that early administration of amiodarone (within 8 minutes) is associated with greater functional survival in OHCA with initial shockable rhythm when compared to placebo.
Source
Survival by Time-to-Administration of Amiodarone, Lidocaine, or Placebo in Shock-Refractory Out-of-Hospital Cardiac Arrest. Acad Emerg Med. 2023 Mar 4. doi: 10.1111/acem.14716. Epub ahead of print.
Spoon Feed
Early identification and treatment of thoracic aortic dissection is paramount to patient survival and good clinical outcomes. Here’s what you need to know.
Spoon Feed
Hyperacute T-waves, when defined by an absolute amplitude threshold greater than the 95th percentile, were not helpful in diagnosing myocardial infarction.
Source
Hyperacute T Wave in the Early Diagnosis of Acute Myocardial Infarction. Ann Emerg Med. 2023 Feb 9:S0196-0644(22)01327-0. doi: 10.1016/j.annemergmed.2022.12.003. Epub ahead of print.
