Getting It Right Despite the Wrong Paradigm

Written by Alex Bracey, edits by Meyers and SmithA 50 something year old male presented to the ED as a transfer from an outside hospital with chest pain. As EMS gave report I looked through the transfer packet for the initial ECG:Sinus bradycardia with loss of R-wave progression and hyperacute T-waves in V2-V5, slight STE in aVL and I without meeting STEMI criteria. There is a down-up T-wave in lead III, which is a very specific reciprocal finding in high lateral OMI. Very highly suspicious of OMI. Applying the 4-variable formula for detection of subtle anterior OMI would yield: STE60V3 = 2.5, QTc = 360, RV4 = 3, QRSV2 = 5 Formula value = 19.6 which is positive for anterior OMI The most accurate cutpoint for the formula is 18.2. A value above 19.0 is very specific for LAD OMI.See more about the use of the formula here.As EMS continued, I noticed that this particular hospital plainly forced the physicians to categorize the ECGs into the false paradigm of STEMI or “no STEMI:”While it is true that this patient did not meet STEMI criteria, it is also true that this is recognizable as OMI and that the patient is in need of emergent reperfusion, ideally by coronary intervention.EMS reported that the patient arrived at the outside hospital with chest pain radiating to both shoulders. He had an ECG performed (above) that was notable for ‘non-specific ST changes.”Serial ECGs had been performed that demonstrated dynamic changes, with the following taken 15 and 45 minutes after ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs