Interventionalist at the Receiving Hospital: " No STEMI, no cath. I do not accept the transfer. "

Are Some Cardiologists Really Limited by Strict Adherence to STEMI millimeter criteria? Yes. We don ' t know how many though.I was texted these ECGs by a recent residency graduate after they had all been recorded, along with the following clinical information:A 50-something with no cardiac history, but with h/o Diabetes, was doing physical work when he collapsed. He was found in ventricular fibrillation and defibrillated, then brought to a local ED which does not have a cath lab.Here is the initial ED ECG:This is pretty obviously and inferior posterior OMI, right?There is slight inferior ST Elevation, with reciprocal ST depression in I& aVL, and an inverted T-wave.There is deep ST depression in V2-V4, also with an inverted T-wave.There is slight ST elevation in V5 and V6.This is diagnostic of an infero-postero-lateral OMISome claim that posterior MI always has an upright T-wave (along with ST depression) in V2-V4;  THIS IS FALSE.  It may be inverted or upright or biphasic during the acute phase.Thisright sided ECG was recorded about 30 minutes after the first:V1R here = V2V2R = V1V3R is further right, etc.There is no right sided STEV1 and V2 have substantially less ST depression.  There may be some spontaneous reperfusion.There is no STE in right sided leads -- no RV OMIThis ECG, in which V4-V6 are on the posterior thorax (V7, V8, V9) was recorded 2 hours later:First, notice that the ST depression in V2 and V3 is almost all gone now.So you would not expect ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs