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Three patients with chest pain and “normal” ECGs: which had OMI? Which were normal? And how did the Queen of Hearts perform?

Dr. Smith's ECG Blog

Written by Jesse McLaren Three patients presented with acute chest pain and ECGs that were labeled by the computer as completely normal, and which was confirmed by the final cardiology interpretation (which is blinded to patient outcome) also as completely normal. It is well known that NOMI usually has a normal ECG or nonspecific ECG.

EKG/ECG 120
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Occlusion myocardial infarction is a clinical diagnosis

Dr. Smith's ECG Blog

Willy is a cardiology fellow with a keen interest in the ECG in OMI. If an immediate EKG was obtained, it was not saved in the medical record. The first available EKG was recorded just after midnight, presumably around the time the result of the troponin came to clinical attention. The patient said, "I just don't feel good."

EKG/ECG 124
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The Expert Witness re-visits a chest pain Malpractice case using the Queen of Hearts

Dr. Smith's ECG Blog

Don't miss his analysis and assessment of the Queen of Hearts AI OMI ECG bot -- that assessment is at the very bottom of the post. Here is her ED EKG: What do you think? I would have very high suspicion for OMI on this ECG. Past medical history included Crohn’s disease, hyperlipidemia, hypothyroidism, and she smoked 1ppd.

EKG/ECG 93
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Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mass delusion (and Opiate pain relief).

Dr. Smith's ECG Blog

I received the following text message with these 3 EKGs (providers text me ECGs all day every day; most are false positives; many are subtle true positives): "Hi Steve, here are 3 EKGs for you (my colleague's case). Opiates are associated with worse outcomes in Myocardial Infarction. Cath attending is aware. Am Heart J.

EKG/ECG 96
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SAEM Clinical Images Series: Wolf in Sheep’s Clothing

ALiEM

Wolf-Parkison-White Syndrome (WPW) Case Question: What are the characteristic ECG findings of this condition and how is this condition managed? These particular EKG findings define a “Wolff-Parkinson-White Pattern.” WPW Syndrome consists of characteristic EKG findings as well as symptomatic arrhythmias. Crit Care Nurse.

EKG/ECG 78
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Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

Dr. Smith's ECG Blog

His prehospital ECG was diagnostic of inferior posterior OMI. Here is his ED ECG: There is bradycardia with a junctional escape. We recorded an ECG in which V1-V3 were put in the position of V4R-V6R, and V4-6 were placed in V7-9 to (academically) confirm posterior OMI. He appeared gray in color, with cool skin.

Shock 97
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Friday Reflection 41: Sometimes I Just Need to Complain

Sensible Medicine

If I had it all to do again, there is no doubt that I would choose medicine in general and academic general internal medicine in particular, but occasionally we all have a bad week. There were no personal crises or untoward patient outcomes. Last week was one of them. 1 What did the medical center do?

Stroke 104