tag:blogger.com,1999:blog-549949223388475481.post3269312012042662769..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Cardiac Arrest -- Is it STEMI?Unknownnoreply@blogger.comBlogger1125tag:blogger.com,1999:blog-549949223388475481.post-6658794560321200342018-04-25T18:00:56.781-05:002018-04-25T18:00:56.781-05:00Absolutely SUPERB case & discussion by Dr. Smi...Absolutely SUPERB case & discussion by Dr. Smith that highlights numerous points regarding ECG interpretation around the period of cardiac arrest. I would add 2 Comments to Learning Point #2, regarding Stress Testing (ETT). The KEY to optimizing safety when doing Stress Testing is to know when to STOP the test. The BEST time to stop (in my opinion), is the instant you (as the one performing the test) become able to decide what the next step in evaluation or management should now be. Usually, the decision is whether or not cardiac catheterization will be needed. Contemplating IN ADVANCE of doing the ETT precisely what result would lead you to refer for cath will greatly facilitate prompt cessation of the exercise test the moment this “End Point” is reached. For some patients, all that might be needed is minimal ST depression in association with symptoms at low level exercise. For practical purposes, this result would confirm significant coronary disease, and continuing the ETT until more ST depression is seen would not really alter management. Not recognizing the clinical “End Point” of when to stop the ETT on a patient such as the one in this case (who had a high-grade fixed obstruction in his LAD) could easily precipitate cardiac arrest during the test. Finally, I will play “Devil’s Advocate” — based on the history that this patient had recently been experiencing exertion angina, and had a markedly positive ETT “a few days prior” — and, was scheduled for cath “the next day” (which means he got to go home for a few days after his ETT …). Deciding which patients with symptoms and markedly positive out-patient ETTs can be allowed to go home for “a few days” before cath — vs which ones should be immediately admitted to the hospital to be prepped that night for cardiac cath done the next morning is indeed challenging … Hindsight is 100% in the “retrospectoscope” — but we should learn from this case how important such decision-making is! THANKS again to Dr. Smith for this highly insightful case!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.com