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ECG Blog #366 — Diltiazem didn't work.

Ken Grauer, MD

The ECG and long lead II rhythm strip in Figure-1 — was obtained from a COVID positive patient with persistent tachycardia not responding to Diltiazem. Figure-1: The initial ECG — obtained from a patient with persistent tachycardia. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195
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Chest pain with serial ECGs – can you guess the sequence?

Dr. Smith's ECG Blog

Below are serial ECGs focusing on the inferior leads and aVL. First, what’s the interpretation of each ECG on its own? #1 2 Normal ECG #3. 2 Normal ECG #3. But 90 minutes later troponin returned at 70ng/L (normal <26 in males and <16 in females), and a repeat ECG was done (ECG#2) for recurring chest pain.

EKG/ECG 96
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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. Her first set of vitals were documented: BP 116/57 Pulse 94bpm Respiratory rate 24/min O2 sat 90% on room air Temp 97F She had been cleaning a Jeep in the sun, and was sunburned. But which artery?

EKG/ECG 89
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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 107
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Four patients with chest pain and ‘normal’ ECG: can you trust the computer interpretation?

Dr. Smith's ECG Blog

All initial ECGs were labeled ‘normal’ or ‘otherwise normal’ by the computer interpretation, and below are the ECGs with the final cardiology interpretation. 1-3] But these studies were very short duration and used cardiology interpretation of ECGs or emergent angiography rather than patient outcomes.

EKG/ECG 117
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Chest pain and a computer ‘normal’ ECG. Therefore, there is no need for a physician to look at this ECG.

Dr. Smith's ECG Blog

Below is the triage ECG, with a computer interpretation (Marquette 12 SL) of “normal” which was confirmed by the over-reading cardiologist. Should this patient continue to stay in the waiting room, without interruption of the physician to interpret the ECG, because the computer interpretation is normal? What do you think?

EKG/ECG 101
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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. Triage documented a complaint of left shoulder pain. If an immediate EKG was obtained, it was not saved in the medical record. A patient with OMI can have a totally normal ECG!" Cardiology was consulted, and repeat EKG was obtained at around 2:30 AM.

EKG/ECG 121