Quiz post - which of these, if any, are OMI? What is the South African Flag Sign? Will you activate the cath lab? Can you tell the difference on ECG?

 Written by Pendell Meyers, additions and edits by Grauer, Smith, McLarenBelow we have 5 cases of adults (ranging from 40-70 years old) who all presented to the ED with acute nontraumatic chest pain that sounded at least somewhat like potential ACS to the provider. You should look at each ECG and decide if it is OMI, not OMI, or something else.Our goal in this post is to compare and contrast OMIs with false positives that mimic them. In this post we will examine the anterolateral distribution that has been described as the " South African Flag Sign. " (SAFS)It is very hard to describe why an ECG expert can easily differentiate these 5 cases. Some of these cases will appear to violate some rules of thumb that are commonly given in rudimentary ECG education. In the end, what matters is accuracy - can you tell which are " real " and which are " fake " ? For now, the only thing that can tell the difference is expert human interpretation by someone who has spent much time to memorize these ECG patterns and correlate them with patient outcomes.Think about faces: you can recognize your friend instantly.  But can you describe why?  Did you measure her nose?  The size of her eyes?  No.  An EKG is like a face and you need to get to know them so you can recognize them.  This is what we hope to teach to artificial intelligence. A short discussion of the SAFS pattern will come at the end for review.Case 1 - this case had a prior ECG availa...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs