Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mass delusion (and Opiate pain relief).

I received the following text message with these 3 EKGs (providers text me ECGs all day every day; most are false positives; many are subtle true positives):" Hi Steve, here are 3 EKGs for you (my colleague ' s case).  A 67 yo f developed chest pain this morning. "EKG #1Followed 15 minutes by this #2 EKG:Then the patient received aspirin andDilaudid (hydromorphone, same effect as morphine) and the pain went away and there was this 3rd ECG:Smith comment: hydromorphone will make any pain go away (or improve) without any improvement in the underlying pathology.  Do NOT give it unless you are committed to the cath lab!!" Cath attending is aware.  I think it is OMI; am I right?  Cath lab declined as it is not a STEMI. "Smith Interpretation: there is diffuse ST depression followed by a hyperacute T-wave. This is classic de Winter pattern, and here it involves both anterior and inferior walls, so this is probably OMI of the mid LAD that also supplies the inferior wall (a " wraparound, " or " Type III, " LAD because it wraps around to the inferior wall).  There is probably a trickle of flow which is why there is both subendocardial ischemia (ST depression) and early subepicardial ischemia (hyperacute T-waves).I sent the last one to theQueen of Hearts #PMCardio app and here is the verdict:My response: " It ’s not even subtle.  It is one of the few OMI patterns that is really well described:de Winter ’s T-waves.And now this finding ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs