Trust a computer read of " Normal ECG " at your peril!

This case was contributed byBrooks Walsh, an emergency physician in Connecticut.Don ' t trust the " Normal ECG "It ' s important to periodically reemphasize that the computerized ECG interpretation  can miss critical findings. Some authors have suggested that ECGs interpreted as " normal " by the computer are "unlikely" to be significant. However, " unlikely " is doing a lot of the heavy lifting in that conclusion!The challenge of emergency medicine, after all, is to churn though the sea of benign presentations, looking for that " unlikely " crucial diagnosis. If you " outsource " this vigilance to the computer, you might miss that critical presentation.The CaseAn older person came to the emergency department with chest discomfort. It was not severe, but it was uncomfortable, and had not improved after an hour.An ECG was obtained immediately at triage: The computer program read this as "Normal Sinus Rhythm, Normal ECG. " Can we trust this?Probably not in this case.First of all, there ' s some pretty suggestive ST elevation in the anterior leads...... along with reciprocal ST depression in lead III.  Seems pretty clearly to be ananterior occlusion myocardial infarction (OMI), but some folks might worry it" doesn ' t meet STEMI criteria " since the STE in V2 doesn ' t clearly exceed 2mm. Further evidence, though, is provided by thesubtle-STEMI calculation in MDCalc. Using the QTc of 421 ms provided by the computer...  ... we get a sc...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs