I saw “Chest pain” on the board and clicked to look at the ECG. Here it is: Much ST elevation in V2 (approx 5.5 mm at the J-point), but the QRS voltage is massive.There is “inferior” STE, but it comes after very high voltage R-waves The ST segment is about 11% of the preceding S-wave.
The OMI Manifesto A collaboration by Dr. Smith’s ECG Blog and EMCrit Pendell Meyers, MD Scott Weingart, MD, FCCM Stephen Smith, MD The current guideline-recommended paradigm of acute MI management (“STEMI vs. NSTEMI”) is irreversibly flawed, and has prevented meaningful progress in the science of emergent reperfusion therapy over the past 25 years. Dr. Stephen
I was reading ECGs on the computer system when this one came up: What do you think? There is apparent ST elevation in III, with reciprocal ST depression in aVL. At first glance, it looks like an inferior STEMI. It also has a wavy pattern reminiscent of hypokalemia. See these cases: Prehospital Ventricular Fibrillation in
Two CasesMale Patient I was handed this ECG of a 40-something male patient. It was recorded at triage. The chief complaint was “chest pain.” The computer interpretation was “Nonspecific”What do you think? Female Patient At the exact same time, I was viewing the computer queue of unconfirmed ECGs (read by computer but not yet overread
Written by Pendell Meyers, edits by Steve Smith A female in her 60s with history of CAD s/p PCI and CABG, alcohol abuse, and recurrent pancreatitis presented at 14:55 complaining of sudden onset epigastric pain. Initial vital signs were heart rate 44 bpm, respiratory rate 16, BP 143/67, SpO2 96% on room air. On initial
This was contributed by one of our fine interns, Aaron Robinson. A 40-something male cancer patient presented to clinic for a routine follow up and stated he was feeling “tired.” He was just finishing a course of antibiotics for bacteremia. His BP was found to be 60 systolic with a heart rate in the 170s.
A 60-something male had a syncopal episode. 911 was called. The patient had no complaint of chest pain or shortness of breath. A prehospital ECG was recorded: Limb leads Precordial Leads There is ST Elevation in V1-V3, and in aVL, with reciprocal ST depression in II, III, and aVF.There is also some ST depression in
Written by Pendell Meyers, with edits from Steve Smith Let’s consider this nearly pathognomonic ECG without the clinical context (because sometimes the clinical context will not be as easy as in this case). What is the answer? This ECG is diagnostic of hemodynamically significant acute right heart strain. Notice I did not say “pulmonary embolism,” because
I happened on this ECG while walking by, and read it with no clinical information, remarked on it, and discussed it with the physicians caring for the patient. The computer read the ECG as completely normal. I heard this clinical information: This patient presented with a “seizure,” and was to be worked up by neurology for