An ECG which is obviously diagnostic of OMI can appear wholly non-specific to most interpreters. A comment on AI.

 This was texted to me by a former resident, with no information:What do you think?Here Ken Grauer has used the PM Cardio app to improve the image:This was my immediate response:" Acute proximal LAD OMI "  To me it is obvious and diagnostic.There are hyperacute T-waves in I, aVL, V2-V6.  These are wide, bulky, with large area under the curve relative to the QRS size.Furthermore, there is a QS-wave in V3 and qrS in V4, both diagnostic of MI at some time (past or present).  We have shownhere and validatedhere that old MI has relatively small T-wave (by amplitude).  In this situation (QS-waves), a T/QRS ratio ＞0.36 in any of V1-V4 is highly specific for ACUTE MI.  The former resident then wrote this:" All my colleagues are amazed that I diagnosed this pretty obvious OMI immediately.  I didn ’t think it was subtle at all but they all say it is. "To my former resident it was alsoobvious and diagnostic.He immediately activated the cath lab.I wish I knew how many clinicians would recognize this diagnostic ECG, and how many would not.Then because he knew there was LAD Occlusion, he suspected that there might be evolution, so he recorded this one 7 minutes later:This shows obvious evolution.  But although it is always a good idea to get serial ECGs, they do not always show evolution, and when they do, it is not always this rapid.  So don ' t let absence of evolution stop you from activating the cath lab with the first ECG.He a...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs