Is this STEMI or NSTEMI? Neither. It is OMI.

 interesting spontaneous reperfusion case 1413140

prehospital STEMI

first ED ECG is here, with 3/10 pain:

But this is the same patient just 10 minutes before, with 7/10 pain

Isn't it ridiculous to say that the patient has both a STEMI and an NSTEMI?

ACS is dynamic.  It can't be given one static name.  This patient has OMI that meets STEMI criteria, then OMI that does not meet STEMI criteria.  Now the patient has one disease: OMI.

Acute anterior lateral STEMI,presented to the ED with 90 min hx of acute onset CP

Culprit is 95% stenosis in the proximal LAD .

Troponins (first is far right, last is far left):

They go quite high, consistent with total occlusion at some point.

Echo 1

Decreased left ventricular systolic performance .

The estimated left ventricular ejection fraction is 35 %.

Regional wall motion abnormality-distal septum anterior and apex large .

Regional wall motion abnormality-distal inferior wall .

EKG next day:

Echo 2 2 days later:

Limited study for LVEF evaluation.

The estimated left ventricular ejection fraction is 40-45%.

Hypokinesis of mid to distal anterior wall, mid to distal anteroseptum,

apical septum, apical anterior, and apical inferior walls, consistent with

infarction in LAD territory.

No obvious left ventricular thrombus visualized, but significant contrast

'swirling' noted in left ventricular apex.

Normal right ventricular size and systolic function.

 

Compared to prior study dated 5/17/2024, wall motion abnormalities are

somewhat less pronounced, and global systolic function has improved. LV

thrombus is not visualized on this study, similar to prior, but

significant contrast swirling at LV apex is suggestive of elevated risk

for thrombus development. Findings communicated with rounding Cardiology

team.