Two prehospital ECGs of patients with chest pain.
Written by Pendell Meyers and Steve SmithHere are two cases of middle-aged men with chest pain who had prehospital ECGs.Patient 1, ECG 1:What do you think? Patient 2, ECG 2:What do you think?Queen of Hearts interpretation of ECG 1:Queen of Hearts interpretation for ECG 2:Interpretation of ECG 1 (OMI): Sinus rhythm, normal QRS, with easily diagnostic signs specific for inferior and posterior wall transmural ischemia, with the most likely etiology of course being acute coronary occlusion MI. Inferior T waves are hyperacute, with reciprocal negative hyperacute T waves in aVL. Posterior OMI is indicated by the inappropriate ST depression maximal in V2. However, I do not believe this case has sufficient STE to meet STEMI criteria.Interpretation of ECG 2: (Not OMI): Thereļ¹„1 mm of ST elevation in consecutive inferior leads (meets STEMI criteria), withno reciprocal ST depression in aVL. There is a slight T-wave inversion in aVL. The upward concavity of the ST segments is pronounced. The T-waves are NOT hyperacute; they do not have much " bulkiness " especially in proportion to the well-formed R-waves. This is a NORMAL ECG.Outcome of case with ECG 2: Inferior STEMI was diagnosed by the emergency physician and the patient needed to be flown by helicopter to a cath lab. The arteries were clean. There was no MI. This was the patient ' s baseline ECG. It was a false positive. The patient ruled out for MI by ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Pendell Source Type: blogs
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