See this " NSTEMI " go unrecognized for what it really is, how it progresses, and what happens

Written by Nathanael Franks MD, reviewed by Meyers, Smith, Grauer, etc.A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. This episode of chest pain began 3 hours ago and was persistent even at rest.Triage ECG at Time = 0: Smith: I am suspicious for posterior OMI due to ST depression in V2 and V3Baseline EKG (several months prior):Smith: Now I am even more suspicious of posterior OMI, as the baseline ECG has normal ST elevation in V2 and V3ECG Interpretation:The triage ECG shows sinus rhythm with subendocardial ischemia pattern as seen by STD in V3-V6, II, III, and aVF, with small reciprocal STE in aVR. The baseline ECG is basically normal with no ischemia.Here is what the Queen of Hearts says about the Baseline ECG:Active chest pain triage ECG also read as not OMI:She says " not OMI " , but she does not have access to the baseline ECG.  In the future, we will be able to have her compare with previous and serial ECGs.You can see in the lead-specific analysis that she " sees " the STD in V5, V5, and II, with STE in aVR as signs of " Not OMI " , because subendocardial ischemia pattern is not the same as OMI. She will be trained to report subendocardial ischemia as a separate diagnosis in her next version. For now she can only say Not OMI. You can also see that she sees leads V2 and V4 as slightly concerning for...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs