Instant easy save if you understand OMI, but incredibly dangerous if you only know STEMI. Readers of this blog will instantly understand this and save lives!

 Written by Pendell MeyersA man in his 60s presented with 1 hour of acute chest pain. Vitals were within normal limits.Here is his triage ECG:30 minutes later:The ECG is a classic, pathognomonic ECG for acute LAD OMI. There is STE in V1 and de Winter morphology (hyperacute T wave with depressed ST takeoff / ST depression) in V2-V4. In the lateral leads V5-V6 and I and aVL there is STD that is likely in part reciprocal to the STE in V1. Also reciprocal STD in II and aVF, or potentially also de Winter morphology in inferior leads as well. With hyperacute T wave and STE in V1 and STD in V5-6, this constitutes an LAD OMI pattern that we are currently studying that we will be describing soon.I do not think this ECG is possible in any other context other than acute cessation of blood flow to an anterior coronary artery. It is pathognomonic in my experience.Of course, it has nothing even close to STEMI criteria.The excellent provider understood the ECG immediately, and activated the cath lab. He persuaded the cardiologist to cath the patient emergently despite lack of STEMI criteria. Cath: 100% (TIMI-0) thrombotic occlusion of the mid LAD, stentedFirst troponin returned at 441 ng/L.All subsequent troponins were greater than 25,000 ng/L.ECG immediately after cath:ECG next morning showing evolution of anterior reperfusion:Echo:EF 45%hypokinesis of mid-apical anteroseptal, anterior, inferoseptal, apical inferior, and apical myocardiumLearning Points:You must understand and re...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs