The ECG must be recorded at the right time, or the Occlusion (OMI) will be missed.

This was sent by one of our faculty, Steven Souchtchenko, who trained under me and works at another hospital most of the time, and with us at Hennepin some of the time.Case:53yoF with stuttering CP for 2 days, suddenly acutely worse tonight, now 10/10 pressing radiating to L arm.  What do you think?Steven wrote: " I called it " OMI " based on hyperacute T-waves. "  (Dr. Souchtchenko understands that a hyperacute T-wave is not at all defined by its height, nor even by its size and bulk (though these are " bulky, " but by its sizein proportionto the QRS)." Cardiology didn ’t believe me.  I recorded a right sided ECG16 minutes later. " Here is the right sided ECG he recorded:Remember that in a right sided ECG, V1R = V2 on the left sided ECG, and V2 = V1.  So here V1 is reflecting V2Look at the first ECG again, and use the 4 variable formula to distinguish normal ST Elevation in V2-V4 from STE in V2-V4 that is due to LAD occlusion:From" SubtleSTEMI " iPhone app, using the4-variable formula:There is a free app forAndroid called " Smith ECG"18.2 is the most accurate cutpoint, with a value higher than 18.2 having about 87% specificity for LAD occlusion.  As with all dichotomous rules, the closer it gets to the cutpoint, the less reliable the value is.The formula is FAR more accurate (more sensitive and just as specific) than ST Elevation " criteria. "Note there are manyexclusions; the exclusions are features that are so specific for LAD...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs