Quiz post: 2 similar patients with similar ECGs. Which, if any, or both, are OMI? Will you outperform the Queen of Hearts?

 Written by Pendell MeyersTwo adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both were awake and alert with normal vital signs. Both cases had an EMS ECG that was transmitted to the ED physician asking " should we activate the cath lab? "What do you think? Here they are:Patient 1, ECG1:Zoll computer algorithm stated: " ***STEMI***, Anterior Infarct "Patient 2, ECG1:Zoll computer algorithm stated: " ST elevation, probably benign early repolarization... "Queen of hearts interpretations:Patient 1, ECG1:Patient 2, ECG1:Patient 1 Clinical Course and Outcome:The EM physician did not see that the S wave voltage has been truncated and squared off at 10 mm, thereby greatly limiting the assessment of proportionality. He diagnosed anterior " STEMI " and activated the cath lab. On arrival to the ED, while waiting for cath lab team, he obtained another ECG:You can now see the full voltage of the high-voltage QRS, likely with some degree of LVH. Now that you can appropriately judge proportionality (one of the many key features that the guidelines totally ignore), you and the Queen can see it is much less concerning. But still,low confidence should not be dismissed, and still requires emergent evaluation.This new ECG was still interpreted as STEMI and the patient was taken to the cath lab where the angiogram showed completely normal coronary arteries throughout. Smith: this ECG is definitely not OMI, but could be mistaken for Sw...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs