Expert human ECG interpretation and/or the Queen of Hearts could have saved this patient ' s anterior wall

This is a re-post of an excellent case from 2021. See it again now, along with our new Queen of Hearts functionality. We ' ve come a long way in 2 years! And the pace only quickens.A man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. He called EMS who brought him to the ED. He had active chest pain at the time of triage at 0137 at night, with this triage ECG:What do you think?I sent this ECG, without any text at all, to Dr. Smith, and he replied: " LAD OMI with low certainty. V3 is the one that is convincing. " After his response I sent him the baseline ECG (below), still with no context at all except that this was his prior ECG:Dr. Smith replied: " Now high certainty. By the way, the formula using QTc of 410 and STE60V3 of 3.5 was 19.4. I bet this LAD occlusion was missed. "  (Also, R-wave amplitude in V4 of 12, and QRS in V2 of 16)I replied: " You ' re right about both. It was LAD occlusion, and of course it was not seen until about 6 hours later. " See side by side below:Now lets see the Queen of Hearts interpretations for these ECGs (remember she receives ZERO clinical context, she receives nothing but the ECG waveform, and she cannot yet compare old vs. new ECG findings):New ECG:Overall interpretation: "OMI with High Confidence"Baseline ECG:Overall interpretation: "Not OMI with High Confidence"You can see that this is an easy call for the Queen, ev...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs