The current STEMI paradigm: Because STEMI criteria are not met, let ' s wait until the myocardium is dead!!

This was sent to me by an inpatient nurse who reads this blog but wants to remain anonymous.An inpatient rapid response was called for a patient with hypotension.  The patient was originally admitted for pneumonia and had been transferred out of the ICU a day prior. He had a history of HFrEF, HTN, and AML. " When I arrived his blood pressure was 70s/40s and he was pale and profusely diaphoretic. " " He spoke Spanish but we did deduce that he had 7/10 chest pain radiating to the back. " " We couldn ’t initially get a hold of the primary physician but our hospital allows the rapid response nurses to begin a work-up through protocols/standing orders so I obtained serial EKGs, a high sensitivity trop, and administered aspirin. "Here is the ECG:The conventional computer read was " Normal sinus rhythm.  Right Bundle Branch Block "What do you think?Smith: this ECG with RBBB is diagnostic of proximal LAD Occlusion (OMI).  Absence of ST Elevation is irrelevant.  There is ﹤1 mm of STE in I, aVL, V5 and V6 (no STEMI " criteria " , and hyperacute T-waves in I, aVL, V5 and V6.This nurse, who reads this blog regularly, immediately recognized OMI, in spite of absence of ST Elevation criteria.Nurse: " I compared it to an admission EKG from four days prior which made me even more concerned. " Here is that previous ECG:No RBBB, and no hyperacute T-wavesFinding and viewing this previous ECG should not be necessary to make the diagnos...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs