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: Source Type: blogs