A patient with chest pain that is resolving. Computer interprets ED ECG as completely Normal.

This study, discussed on Salim Rezaie ' s fine site REBEL EM, implies you can trust the computer interpretation of " normal. " (http://rebelem.com/triage-ecgs-reducing-interruptions-busy-ed/)We recently wrote an editorial debunking this study: Litell, John M., H. Pendell Meyers, and Stephen W. Smith. 2019. “Emergency Physicians Should Be Shown All Triage ECGs, Even Those with a Computer Interpretation of ‘Normal.’”Journal of Electrocardiology 54 (March): 79 –81. https://doi.org/10.1016/j.jelectrocard.2019.03.003.What to do?Recording serial ECGs would be useful. The chest pain is resolving, so if these are resolving hyperacute T-waves, then followup ECGs should show their size diminishing.However, when I saw this patient, I knew that he had come by ambulance, so I knew there must be a prehospital ECG recorded somewhere and went to look for it. I found it. Here it is:Need I say more?Yes, I ' ll say more: see the computer interpretation:"Normal variant ST elevation, consider early (repolarization)"Why the medics did not see it, I ' m not sure. The cath lab was activated, as it should be with transient STEMI. See this case of transient STEMI:Spontaneous Reperfusion and Re-occlusion - My Bad Thinking Contributes to a Death.Angiogram: There was 80% obstruction of the LAD with a large thrombus and TIMI-2 flow; the thrombus was suctioned out.All serial troponins were undetectable! (Remember this the next time you think ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs