Why doesn ' t the name " OMI " say anything about the ECG, in contrast to STEMI? Because sometimes the ECG isn ' t always enough, no matter who interprets it.

Written by Pendell MeyersA man in his 60s with history of prior CAD with PCI, HTN, HLD, and aortic insufficiency presented with acute chest pain radiating to the left arm. He had been walking on a treadmill for approximately 5 minutes when the symptoms began abruptly. He had associated shortness of breath, diaphoresis, and dizziness.He arrived by private vehicle with relatively normal vitals signs and this initial ED ECG:What do you think about the patients clinical presentation? About the ECG?The patient: the treating team was completely convinced of ACS (or less likely another catastrophe such as dissection) by his symptoms and clinical appearance before the ECG was recorded.The ECG read prospectively: Both I and Dr. Smith read this ECG (without any clinical information) as having no convincing evidence of OMI. We both noted the slight STE in V1 along with minimal STD in V6, I, and aVL, stating that these findings were possibly concerning and that we would perform serial ECGs as well as clinical info, echo, etc, to help the decisions further. We have described the pattern of STE in V1-V2 with lateral STD in cases of LAD occlusion, but we both agreed that something about this ECG just doesn ' t fit that pattern. But overall with this ECG in isolation (no clinical context, no baseline available to us at that time), we did not see evidence of OMI.Smith comment: There is a touch of STE in V2 and V3, so one might wonder if this is subtle LAD occlusion. The formula value (using Q...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs