75 year old with 24 hours of chest pain, STEMI negative

Written by Jesse McLaren A 75 year old
with a history of CABG called EMS after 24 hours of chest pain. HR 40, BP
135/70, RR16, O2 100%. Here ’s the paramedic ECG (digitized by PMcardio). What
do you think? There ’s sinus
bradycardia, normal conduction, normal axis, delayed R wave progression, and
normal voltages. There are inferior Q waves and lead III has mild concave ST
elevation, with subtle reciprocal ST depression in I/aVL. This is diagnostic of
inferior OMI, likely from the RCA. The patient has a hi story of CABG so some of
these changes could be old, but with ongoing chest pain and bradycardia in a
high risk patient this is still acute OMI until proven otherwise. I sent the ECG
to Dr. Meyers without any information, and he immediately replied, “inferior
OMI.” I also sent this to the PMcardio app Queen of Hearts. Trained by Smith
and Meyers, it delivered the same immediate reply of OMI with high confidence:  But there are
multiple barriers to getting the patient to the cath lab: a.STEMI negative: the EMS automated
interpretation read, “STEMI negative. Inferior infarct, age undetermined. Sinus
bradycardia.” According to the STEMI paradigm, the patient doesn’t have an
acute coronary occlusion and doesn ' t need emergent reperfusion, so the
paramedics can bring them to the ED for assessment, without involving
cardiologists. But the latest ACC consensus on the evaluation of chest pain in
the ED warns that “STEMI criteria will mi...

Source: Dr. Smith's ECG Blog - June 8, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs