How much time are you willing to wait for OMI to become STEMI (if it ever does)?

Written by Pendell Meyers, few edits by SmithA man in his 60s with history of stroke and hypertension but no known heart disease presented with chest pain that started on the morning of presentation at around 8am.Here is his triage ECG when he presented at 1657:What do you think?There is sinus rhythm with normal QRS complex and ST depression in V2-V5, maximal in V3-V4. There is no ST depression in V6, II, III, or aVF, and no significant ST elevation in aVR, all confirming that the ST vector is not consistent with diffuse subendocardial ischemia, but rather a focal ST vector pointed at the posterior wall. It is posterior OMI until proven otherwise.This ECG is quite obvious for long-time readers, and you may think this far too easy to be presented on this blog.But in actual practice, similar patients are routinely missed and under-treated, as you will see as this case progresses." Posterior STEMI " may not even technically exist according to the current (2013) ACC/AHA STEMI guidelines, as it is not described as a " STEMI equivalent " and the only relevant statement in the guidelines is: " In addition, ST depression in 2 precordial leads (V1-V4) may indicate transmural posterior injury. "  JACC 61(4):e78-140; page e83.Furthermore, the term " STEMI equivalent " has no reliable or definable meaning except between two practitioners who both agree on the list of entities that they believe are STEMI equivalents and can agree on how to identify it.It is true that other docum...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs