Smacc

Previously at SMACC, Steve talked about NonSTEMI that needed the cath lab immediately and showed many ECGs which represented acute coronary occlusion (Myocardial Infarctions) but present on the ECG as very subtle findings (http://hqmeded-ecg.blogspot.com/search?q=subtle), particularly as subtle ST segment elevation that does not meet “STEMI” criteria and is diagnosed as NonSTEMI. Now, he builds on that idea and challenges the whole idea of a dichotomy between STEMI and NonSTEMI. These are NOT distinct pathologies, but rather exist on a continuum of intracoronary thrombus. Nevertheless, this false dichotomy is rarely recognised by emergency physicians or cardiologists, and patients suffer because of it. There are obvious STEMI, which always need the cath lab emergently, and for which time is myocardium. On the other hand, there are patients whose symptoms are resolved, ECG is non-diagnostic, shows no active ischemia nor subtle ST elevation, but whose troponin is positive and their resolved chest pain is due to