A " normal ECG " on a busy night

Written by Pendell MeyersWe walked in to an overnight shift with approximately 70 patients in the waiting room and a room full of sign-outs at midnight. At 3:55 AM during that kind of a night shift, this ECG (among many others) was brought from triage for review by my team.We knew only that the ECG belonged to a man in his 50s with chest pain and normal vitals. No prior available.Here is the computer interpretation:So we have a triage-computer-normal ECG.Don ' t bother me with this, right?I ' m sure you can imagine the cognitive burden we had during this type of night. On first review from triage, my attending and I waffled about this ECG for a few minutes.  It is amazing what the mind will do subconsciously when it is trying to conserve dwindling energy in a stressful situation.Then we snapped out of it and were terrified that we almost missed this. It is clearly high lateral Occlusion MI (OMI) until proven otherwise.There is a small amount of STE in I and aVL (though slightly less than 1mm in each) with reciprocal STD in III and aVF. Lead aVL has a Q-wave which must be assumed new in this scenario. There is no clear evidence of posterior or lateral involvement, however comparison with a prior (which was unavailable) may have shown evidence of this by comparison.Let ' s zoom in on I and aVL:Lead I (top panel) has less than 1mm of STE. Lead aVL has a Q-wave followed by about 0.5mm STE with possibly terminal T-wave inversion.We brought the patient into one of our critical...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs