My God! Your diction is impressive. Thank you very much for the knowledge passed here. The technical level demonstrated here is excellent, with old paradigms and dilemmas on the way to a possible solution. The diagnostic model of AMI with Q and AMI without Q from the 1980s did not make sense at that time. In the next and current ST model for more than 20 years, they already indicated a loss of 15% of infarcts with occlusion, but statistics have shown that it reaches more than that, reaching up to 40% in some studies. This new model reminds us of that, but it still doesn't solve how to find all these so-called NON STEMI occlusions. I think what will get us out of this new/old dilemma will be a new biochemical marker, or lessening the rule for angiography in these cases.
Another consideration for morphine and ACS. In a situation where you have an NSTEMI, cardio is made aware and recc medical mgmt, morphine should be cautiously used (if not entirely omitted) because it can mask worsening chest pain (in the setting of utilizing nitro). Chest pain that is resistant to titration nitroglycerin infusion in the setting of an NSTEMI is an indication for emergent cath. Some won’t start morphine until cardio agrees to prep the cath lab for these types of patients
I was hoping that can clarify something for me please. You correctly discuss the OMI manifesto as outlined by Dr Smith however then go on to discuss the outdated idea of STEMI criteria by mm. Many patients will not meet such mm criteria due to smaller sized QRS complexes, or when they do it will be minutes or likely hours down the track when myocardium has already been lost. My understanding is that the OMI manifesto is about early pattern recognition particularly hyper acute T waves and reciprocal ST depression to capture occluded coronary arteries early on in the process. Dr Smith’s blog has many examples of such ECG’s and the result of missing such early changes. Many thanks
Im a medical coder & Ive always hated coding Cardiology, until now..everything is so much clearer for me now THIS IS EXACTLY WHAT I NEEDED! may this woman be blessed for eternity 😘
Any guidance of applying oxygen for shock? (Example - inferior STEMI, bradycardic, hypotensive, cool/pale/diaphoretic) I keep hearing mixed things from different attendings
Nitroglycerin a venodilator how dose it help in stable or unstable angina artery is constricted what is the use of dilating vein how come it increase the perfusion to infracted area
Wellen’s ST changes is another high risk feature.
This was so informative and very well presented, Thank you!!
I loved how this cleared my concepts so clearly and it is so clinically/practically useful!
My God! Your diction is impressive. Thank you very much for the knowledge passed here.
The technical level demonstrated here is excellent, with old paradigms and dilemmas on the way to a possible solution.
The diagnostic model of AMI with Q and AMI without Q from the 1980s did not make sense at that time. In the next and current ST model for more than 20 years, they already indicated a loss of 15% of infarcts with occlusion, but statistics have shown that it reaches more than that, reaching up to 40% in some studies. This new model reminds us of that, but it still doesn't solve how to find all these so-called NON STEMI occlusions. I think what will get us out of this new/old dilemma will be a new biochemical marker, or lessening the rule for angiography in these cases.
Amazing presentation 👏
Amazing head and shoulders presentation.
Another consideration for morphine and ACS. In a situation where you have an NSTEMI, cardio is made aware and recc medical mgmt, morphine should be cautiously used (if not entirely omitted) because it can mask worsening chest pain (in the setting of utilizing nitro). Chest pain that is resistant to titration nitroglycerin infusion in the setting of an NSTEMI is an indication for emergent cath. Some won’t start morphine until cardio agrees to prep the cath lab for these types of patients
I was hoping that can clarify something for me please.
You correctly discuss the OMI manifesto as outlined by Dr Smith however then go on to discuss the outdated idea of STEMI criteria by mm. Many patients will not meet such mm criteria due to smaller sized QRS complexes, or when they do it will be minutes or likely hours down the track when myocardium has already been lost. My understanding is that the OMI manifesto is about early pattern recognition particularly hyper acute T waves and reciprocal ST depression to capture occluded coronary arteries early on in the process. Dr Smith’s blog has many examples of such ECG’s and the result of missing such early changes. Many thanks
Im a medical coder & Ive always hated coding Cardiology, until now..everything is so much clearer for me now
THIS IS EXACTLY WHAT I NEEDED! may this woman be blessed for eternity 😘
Wonderful talk
Very nice presentation.
Also can you tell difference between stable vs unsable angina
stable: Symtoms with exertion, no ECG changes.
Unstable: symptoms at rest, unpredictable. There may also be ECG changes.
Any guidance of applying oxygen for shock? (Example - inferior STEMI, bradycardic, hypotensive, cool/pale/diaphoretic) I keep hearing mixed things from different attendings
Great lecture!!
Excellent speaker!
Curious why we have a range for ASA rather than one set dose. Is it 162 or 325? Why one over the other?
Excellent 👋🏻
so clear
thanks
Nitroglycerin a venodilator how dose it help in stable or unstable angina artery is constricted what is the use of dilating vein how come it increase the perfusion to infracted area
It dilates arteries as well, relaxes the smooth muscles with vessel walls.
@@lisachesters4991 thankyou okey could you tell the source bro
983 Horacio Branch
Fabulous thanks
Cronin Harbor
Wow she is gorgeous.
Hegmann Pine
Madie Point
34:11 did you remember what it was?
Probably wellens?
Or aslangers pattern
Lee Nancy Moore William Clark Gary
Clean coronarography = non cardiaque ?
Wow.... takotsubo, pericardite, myocardite...