The machine read the initial EKG as normal but I found the inferior leads and V2 concerning. After evaluating the patient, I ordered a posterior EKG, which looked a bit different. The posterior leads were fine but the inferior leads had evolved into an absolute STEMI. A few learning points.
What were her trop I and T levels, and at what intervals? Fascinating case. Thanks
High sensitivity trop was drawn during the initial EKG and was 510, pretty low. I think we happened to catch the evolution of a worsening infarction with the 2nd EKG.
Wow - brilliant catch.
Better to be lucky than smart 😁
Appreciate the learning point!
Interesting that the highest confidence was on V2 when the posterior EKG was fine.
I know Steve Smith strongly discourages using posterior leads to "prove it's a posterior MI," since it's easy for those leads to be falsely negative
Is that an app?
The Queen of Hearts! Also known as PM cardio. Steve Smith at Hennepin helped develop it, I think it has FDA approval now
Also recent study showing effectiveness www.sciencedirect.com/science/arti...
Wow! Cool.
1. The EKG machine will lie to you. 2. Never be afraid to get serial EKGs if you're concerned. TBF, I do not think cards would have activated the cath lab based on the first EKG and the patient in front of me but the 2nd EKG made that moot.
This is such a good teaching point. I’m sure you’ll get ppl in your comments saying this is absolutely an OMI and you should tell that dumb cardiologist to come in and do the cath and maybe, yeah, or—take a moment and get another data point and obviate the whole argument
100%!
Patient was in good hands.
That, ma'am is a great catch!
How much time between the first and 2nd EKGs?
About 25 minutes.
1st EKG is diagnostic for inferior-posterior OMI. As u say, can u convince cards to cath based on first one? That’s our constant challenge in the ED. Fortunately the EKG evolved but the STEMI paradigm has to go.
Patient was in good hands.
❤️🩹
