Test yourself: how many hours between your diagnosis of OMI and positive STEMI criteria?

Written by Pendell Meyers, with edits by Steve SmithA male in his early 40s presented with intermittent chest/abdominal pain. He admitted to several episodes over the past two days, including one episode several hours prior to presentation, described as severe (8/10), substernal " burning, " non-radiating, associated with diaphoresis, described as " feeling food stuck in my throat, " or " like I ate too fast, " but not associated with eating, relieved by belching and flatulence, relieved by lying flat. The episode on the day of presentation was similar except he had the additional new features of " burning ears " and " blurry vision, " which prompted him to finally go to the ED. His history included known CAD (prior cath two years ago showed a 60% mid-LAD stenosis and 60% 1st diagonal stenosis), as well as early CAD in several close relatives.Upon evaluation in the ED, he states that his pain had completely resolved just before arrival of EMS.Here is his first ED ECG (no priors available):I read this as normal. I see no evidence of ischemia, no evidence of OMI.I would not have applied the the subtle anterior OMI vs. early repol formula to this ECG, as the formulas were not designed for cases with no STE (early repolarization, otherwise known as " normal variant STE, " implies that there is STE). Had this been my case prospectively, I would not have identified OMI at this time. This is supported by the patient ' s lack of chest pain at the time of the ECG, likely meaning ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs