A 40-something male with resolving chest pain and a " Normal ECG " by computer and cardiology overread

A 40-something male presented by ambulance with one hour of chest pain that was improving after sublingual nitroglycerine and 325 mg of aspirin, chewed.  Here is his initial ED ECG:What do you think?I read this ECG without any history as reperfusing inferior and posterior OMI due to the Q-wave in lead III with minimal STE and reciprocal ST depression in V2-V4 (which should never be there).  The large upright T-wave in V2 is consistent with reperfusion.Any ST Depression Maximal in V1-V4 is OMI until proven otherwiseI sent this ECG with no information to Pendell.  We send each other EKG by the dozens every day.  Most are OMI look alikes (mimics).  So when he sees OMI on the ECG, or reperfusing OMI, it is not because there is a high pretest probability.  It is because he is VERY good. He responded: " reperfusing inferior posterior OMI "I sent it to the #PMCardio AI Bot (AKA Queen of Hearts) and she responded with" OMI mid confidence " )But the conventional algorithm read this as " Normal ECG "And the overreading cardiologist (also with no clinical context) read this as " Normal ECG "Now I need to tell you thewhole story:This patient actually had a prehospital ECG while his pain was intense.  Here it is:Obvious Inferior Posterior STEMI (+) OMI.The cath lab was activated prehospitalBut imagine if the patient had walked in.  Or had not had a prehospital ECG on the ambulance.  Then the ED doc would be dependent on that firs...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs