Acute Chest pain in a 50-something, and a " Normal " ECG

Chris Mondie of the Newark Beth Israel Emergency Medicine Residency sent this caseA 50-something man presented with acute chest pain.Here is his ECG:As you can see, the computer called it completely normalWhat do you think?The computer did not even mention the ST elevation.  It could at least say: " ST Elevation, consistent with normal variant, " or " consistent with ischemia or normal variant, " or " consistent with early repolarization. "  But it simply says " normal. " An interpretation of " normal " could, of course, deceive many providers.AnalysisThis could be normal variant ST Elevation in V2 and V3.  There is 1.5 mm STE in at the J-point in lead V2 (relative to QRS onset, otherwise known as PQ junction).  There is 1.0 mm in V3.So this is a normal amount of STE in V2 and V3, defined by Universal Definition of MI as up to 2.0 mm in men over age 40.  So there is definitely no STEMI, and the STE is normal.  So the computer is correct in calling it normal.But after reading this blog, you all know thatmost OMI do NOT meet STEMI criteria.  Some patient ' s baseline ECG haszero STE.  Some patient ' s baseline has normal variant STE.  You don ' t know which kind of patient this is.Some normal STE is actually due to OMI.  Some normal STE is not due to ischemia at all.It is your responsibility to determine if STE is ischemic or not.How do we do so?Use the formula.QTc = 385STE60V3 is at least 4.0 mm, maybe moreR...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs