Teach your learners: when the QRS is wide, the J-point will hide, so trace it down and copy it over!

Case submitted by Alexis Cates, written by Pendell MeyersA middle aged man with history of HTN, DM, and VSD repair at age 6, presented to the ED with chest pain and diaphoresis while exercising.Here is his initial ECG:What do you think?Hopefully this is too easy for most readers, but it it shows a massive, obvious inferoposterior OMI, in the setting of sinus tachycardia with RBBB and LPFB. It may be too easy for you, but there is a very valuable teaching point for you as you spread ECG knowledge to your group, your residents, your learners.Over the past 3 years I have shown this ECG and many similar ones to many residents and medical students, and it has become apparent to me that there is a very powerful pitfall in beginner ECG interpretation that happens when an abnormal and/or bizarre QRS complex attempts to hide the J-point from the learner. Their mental framework is to find the ST segment and then measure the ST deviation. This framework is obviously very inaccurate for its purpose of identifying Occlusion MI, but at least it provides an approach for the beginner. This is easily doable for the learner in regular QRS complex conduction, but then they encounter an abnormal QRS conduction and things get much more difficult because the classic STEMI paradigm teaching basically only applies to normal QRS complexes. In my medical school curriculum, there was essentially no teaching or understanding of what to do in the STEMI paradigm if the QRS is abnormal, or when the J-point...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs