The Diagnosis of OMI does not depend on the ECG. But if you recognize it, that ' s great.

An elderly woman presented with 4 days of waxing and waning epigastric/substernal chest pain, worse on the day she presented.  She described the pain as a constant chest pressure, 6/10, without radiation to left arm, jaw or back, and without change in with breathing or movement.Here is her ED ECG:This was read as non-specific.  What do you think?I found this case while looking through a stack of ECGs, without clinical information.  I immediately thought " Acute LAD occlusion. "  Why?  There are QS-waves in V2-V4.  These suggest old anterior MI, or subacute MI.  But as we ' ve described many times,old MI does not have large T-waves!  The T/QRS ratio in V4 is 6/10 = 0.6.  If any single ratio in V1-V4 is greater than 0.36, it is acute MI, not subacute and not old.  Notice I said the LAD is occluded, but there is nearly zero ST Elevation!  This is why we need to change the name of acute MI due to acute coronary occlusion from STEMI to OMI.In fact, there was an old ECG available from 16 days prior.  Here it is:This confirms that the QS-waves are new, as are the large T-waves.The patient was treated with aspirin and nitroglycerin, but she had persistent pain.The first troponin returned at 1,950 ng/L. This, in the context of persistent pain, is all but diagnostic of acute coronary occlusioneven without the ECG.  The fact that the troponin is so high is consistent with the prolonged pain (e...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs