Memorize the squiggly lines - it helps save lives.

Sent by Logan Stark, MD, written by Pendell MeyersDr. Stark sent me this ECG below and said " Curious on your thoughts without context. "Here is the PM Cardio version of this phone screenshot:I replied:" The concern without context would be possible LAD OMI signs. There is poor R wave progression, slight STE, hyperacute T waves in V2-V5, reciprocal STD in inferior leads. "He gave me the context:A middle aged man had sudden chest pain and arrested in front of his family. His wife immediately performed CPR.EMS arrived and defibrillated him. He was already awake and alert by arrival to the ED.He had persistent chest pain.Providers immediately recorded this ECG (same as the ECG above):Around 20-30 minutes later, this ECG was recorded:The patient was taken quickly to the cath lab where a 100% acute thrombotic LAD occlusion was opened and stented.He survived. Learning Points:ECGs can be very specific when it comes to many diagnoses, including OMI. As Dr. Smith says, it is usually the interpreter who is nonspecific, not the ECG.(Until AI develops for ECG interpretation), you must simply memorize morphologies and patterns that correlate with OMI in order to learn it.Acute LAD OMI diminishes the R waves in the anterior leads, which is why it was the most important variable in the 4-variable formula for differentiating normal variant STE from subtle LAD OMI. Myocardium that is ischemic cannot conduct the action potential as well, resulting in less R wave than previously.If yo...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs