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Interns are not (yet) poisoned by the STEMI/NSTEMI paradigm

Dr. Smith's ECG Blog

Now as an intern, he is exceptional at EKG interpretation because he was able to learn of the OMI paradigm and importance of pattern recognition before getting poisoned by years of learning STEMI. This is really a transient OMI (or transient STEMI if one uses that terminology and it has diagnostic ST Elevation). The rhythm is sinus.

STEMI 70
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LV aneurysm with T-wave increased in septic/hypotensive tachycardia

Dr. Smith's ECG Blog

consult: In summary, this is a 47 year old male with past medical history of CAD s/p STEMI in 2010 s/p PCI to LAD with BMS, HTN, tobacco, alcohol and substance abuse that presented with chest pain and found to have ST elevation with T wave inversion in his ECG.

CAD 52
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Two Cases: Was it an error to activate the cath lab? Add AG case for 3rd one, except it is already listed as inferior aneurysm case.

Dr. Smith's ECG Blog

ED echo: The left ventricular ejection fraction appears: Severely reduced No pericardial effusion identified. Remember that 1/3 of MI (both STEMI and NSTEMI) present without chest pain, and that is even more common in women and the elderly. Multivessel CAD 2. A line predominance, no B lines E-point septal separation 2.24

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Infection and DKA, then sudden dyspnea while in the ED

Dr. Smith's ECG Blog

While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain. The patient had no chest symptoms until he had been in the ED for many hours and had been undergoing management of his DKA. The patient was under the care of another ED physician. Another ECG was recorded: What do you think?

ED 125
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An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?

Dr. Smith's ECG Blog

This was sent by an undergraduate (not yet in medical school, but applying now) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly. Of course, writing “hypertensive emergency, underlying CAD with demand ischemia, or NSTEMI all remain on the differential” makes no sense.

CAD 132
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Expert human ECG interpretation and/or the Queen of Hearts could have saved this patient's anterior wall

Dr. Smith's ECG Blog

A man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. He called EMS who brought him to the ED. She knows the baseline is normal, and she knows the STEMI(-) OMI one is diagnostic of OMI, with the highest possible confidence.

OR 134
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An 80 year old woman with Left Bundle Branch Block (LBBB) and pleuritic chest pain

Dr. Smith's ECG Blog

The patient presented to an outside hospital An 80yo female per triage “patient presents with chest pain, also hurts to breathe” PMH: CAD, s/p stent placement, CHF, atrial fibrillation, pacemaker (placed 1 month earlier), LBBB. Most large STEMI have peak troponin I in the 20.0 There are hyperacute T-waves in V5 and V6. Next trop in AM.

CAD 118