Is OMI an ECG Diagnosis?
Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency
department with 2 weeks of increasing exertional chest pain radiating to the
left arm, associated with nausea. The pain recurred at rest 90 minutes prior to
presentation, felt like the patient ’s prior MIs, and was not relieved by 6
sprays of nitro. Paramedics provided another 3 sprays of nitro, and 6mg of
morphine, which reduced but did not resolve the pain. What do you think of the ECG, and does it
matter?There ’s normal sinus rhythm, LAFB, old anterior Q waves,
and no diagnostic sign of OMI. I sent this to the Queen of HeartsSo the ECG is both STEMI negative and has no subtle
diagnostic signs of occlusion. But does this matter? The ECG is just a
test: a Bayesian approach to acute coronary occlusion If a patient with a recent femur fracture has sudden onset
of pleuritic chest pain, shortness of breath, and hemoptysis, the D-dimer
doesn ’t matter: the patient’s pre-test likelihood for PE is so high that they
need a CT. Similarly, if a patient with known CAD presents with refractory
ischemic chest pain, the ECG barely matters: the pre-test likelihood of acute
coronary occlusion is so high that they need an emergent angiogram. Non-STEMI
guidelines call for “urgent/immediate invasive strategy is indicated in patients
with NSTE-ACS who have refractory angina or hemodynamic or electrical
instability,” regardless of ECG findings.[1]...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Jesse McLaren Source Type: blogs
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