A 50-something with acute chest pain, a computer " Normal " ECG, and a HEART score of 3 (low risk)

A 50-something with no previous cardiac history and no risk factors presented to the ED with acute chest pain (pressure) that radiated to the left arm.  An ECG was immediately recorded:Computer read: Normal ECGWhat do you think?There is ST depression in V1-V3.  We showed that this isdiagnostic of OMI (of the posterior wall). Moreover, there is ST elevation in V6 (which is getting close to the location of posterior lead V7).  Thre is also absence of S-wave in V6, which is not entirely abnormal, but is suggestive of OMI (when this finding is in V2 or V3 in the setting of STE in V2 or V3, we call this "terminal QRS distortion" , and it rules out normal STE)Later, it queried the PM Cardio AI bot ( " Queen of Hearts, " a deep neural network trained by Pendell and me), and its diagnosis was " OMI with High confidence "Case continuedThe faculty physician in triage was very suspicious of OMI and took the patient to the critical care area.  Another very astute faculty physician immediately recognized that the ECG isdiagnostic of posterior and lateral OMI, and activated the cath lab.The cardiology fellow came  to the ED.  Another ECG was recorded as the patient ' s pain was improving.This one is far more subtle, and if it were the only ECG, it would be difficult to call it diagnostic.The Queen of Hearts does not know that there were other ECGs, and does not know the patient.  Nevertheless, it diagnosed:  " OMI with Mid Confide...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs