A man in his 60s with diaphoresis, vomiting, and inferior STE

Written by Pendell MeyersA man in his 60s appeared altered and diaphoretic and vomiting to a bystander, who called EMS. EMS personnel agreed that he was altered, possibly intoxicated, and seemed to deny all complaints that EMS inquired about. Vital signs were within normal limits.EMS performed an ECG:What do you think?Raw findings: - Sinus rhythm - Normal QRS, axis straight down at lead aVF - STE in leads II (2.0 mm), III (1.5 mm), aVF (2.0 mm) - STD in aVL (1.0 mm) - STD in V1 (0.5 mm), STD in aVR (0.5 mm)Subjective interpretation of those findings:It is slightly tough to decide whether this is inferior and/or posterior OMI. " Normally " , this ECG would trigger the rule that any STE in the inferior leads with any STD and/or TWI in lead aVL (not explained by some other reason, like a QRS abnormality) should be considered inferior OMI until proven otherwise. " Normally " , we would teach that STD maximal in V1-V4 (without another explanation e.g. RBBB, juvenile T wave pattern, known prior baseline, etc.) should be considered posterior OMI until proven otherwise. But there is something about this particular ECG and its morphology that matches prior false positives to me. I have a hard time explaining what feature it is, exactly, but I have made lots of mistakes in the past and feel that this one is similar to the last time I saw a false positive like this. One thing I can explain is: Any time there is focal STE in the inferior leads for any reason (whe...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs