Inferior ST elevation with reciprocal change: which of these 4 patients has Occlusion MI?

Written by Jesse McLaren, with comments by Smith and Grauer Four patients presented with cardiorespiratory symptoms, with inferior ST elevation and reciprocal change on their ECG. Which patient had occlusion MI?  Note: according to the STEMI paradigm these ECGs are easy, but in reality they are difficult. First let ’s start with each ECG without clinical context. What do you think of each ECG? ECG 1: ECG 2:ECG 3:ECG 4:Now let ’s introduce some clinical context. How would this change management? Patient 1: 30 year old previously healthy, presenting with syncope, now asymptomatic with normal vitalsECG: normal sinus rhythm, normal conduction, vertical axis, normal R wave progression, no hypertrophy.There ’s inferior STE which meets STEMI criteria, but this is in the context of tall R waves (18mm) and relatively small T waves, and the STD/TWI in aVL is concordant to the negative QRS. I sent the ECG to Dr. Smith without any clinical context and he replied: " not OMI " because it looks so much like normal variant. Because the patient was asymptomatic the emergency physician didn ’t activate the cath lab but got a stat cardiology consult. The patient had serial ECGs that were unchanged, serial high sensitivity troponin I were undetectable, an echo was normal, and the patient was discharged with a diagnosis of vasovagal syncope and a copy of their ECG for future ED visits. So this ECG false positive STEMI, which could be recognized by e...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs