A Patient with Respiratory Failure and a Computer " Normal " ECG

This ECG was presented in a conference.The patient had presented many times for SOB.  On this occasion he was intubated for respiratory failure due to presumed asthma.I was asked to interpret his ECG in the conference.  I had never seen it before.ECG-1:What do you think I said?Here is the computer interpretation:This is what I said: " This is diagnostic of an acute inferior MI.  There is upsloping ST elevation in III, with reciprocal ST depression in aVL.  You do NOT see this in normal variant STE, nor in pericarditis.  The only time you see this without ischemia is when there is an abnormal QRS, such as LVH, LBBB, LV aneurysm (old MI with persistent STE) or WPW. "This was not seen by the providers.He had another ECG 2 hours and 45 minutes later, before being admitted to the ICU:ECG-2:Now it is more obvious.It is unclear if treating physicians saw this.The formal read, done by someone not caring for the patient, was:Inferior MI of indeterminate age.If you see this ECG in isolation, that is true.There are well-formed Q-waves and T-wave inversion.The patient was managed in the ICU and had serial troponins.Here is the patient's troponin I profile:These were interpreted as due to demand ischemia, or type II MI.First was 2.9 and subsequent go down to 1.5Such high troponin I is very unusual in type 2 MI.Here is data from a study we published in 2014 for type II NonSTEMI:Sandoval Y. Nelson SE. Smith SW. Schulz KM. Murakami ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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