A Text Message in the Middle of the night. Do you give thrombolytics?
I awoke in the morning and discovered a text with this ECG that was sent 6 hours prior by a former resident:" 60 year old with classic chest pain. The cath lab is occupied for the next 90 minutes. Cards says " not a STEMI " . Thinking of giving lytics. "What do you think?What do you do?I texted back: " Sorry for delay! Was sleeping. This is OMI!! Did you give lytics? Proximal LAD. Great catch! "There is 0.5 mm of ST Elevation in V3-V6. The T-wave in V4 is far too large for the QRS. The LAD occlusion formula would be very high due to the extremely small R-wave in V4 and QRS in V2, but without the QT I cannot calculate it exactly.This ECG is diagnostic of LAD OMI. Occlusion Myocardial Infarction.I continued:" Cards was right. It is not a STEMI. But the new paradigm is OMI. And that is what is important. ST Elevation is a very poor way to define myocardial infarction. We have a couple articles, one in press and one in review, that we hope will continue to prompt a change in that inadequate paradigm. "More about the case:History: 60 yo woman w/ history of smoking but no other cardiac risks who presented to triage w/ CP. She had awoken in the morning w/ bilateral arm paresthesias and by evening called a nurse advice line who told her she may be having a heart attack and to go to ED to be evaluated.While in her car she developed central chest pressure radiating to right shoulder about 20 min p...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Steve Smith Source Type: blogs
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