Join in the conversation between Scott Weingart and Steve Smith as they discuss who should go to the cath lab on Dr. Scott Weingart's EMCRIT two part podcast or check out the pdf cheat sheet from Dr. Smith on which patients should go to the cath lab and when to engage you cardiologist for consult.
Dr. Mattu reminds us that one ECG begats another. If something doesn't look or feel right, repeat the ECG. He sites a paper documenting 11% MI's not seen on initial ECG in a study of over 41K pt's! (Check out link below)
aVL, V2 depression can be reciprocal changes for inferior MI.
Diagnostic Time Course, Treatment, and In-Hospital Outcomes for STEMI Patients Presenting with Non-Diagnostic Initial ECG: A Report from the AHA Mission: Lifeline Program
Robert F. Riley, MD, L. Kristin Newby, MD, MHS, Creighton W. Don, MD, MSE, PhD, Matthew T. Roe, MD, MHS, DaJuanicia N. Holmes, MS, Sanjay K. Gandhi, MD, Michael A. Kutcher, MD, and David M. Herrington, MD, MHS
Dr. Smith urges us to know the Sgarbossa Criteria and advocate for our patients. Start with his blog post here:
The original criteria used to diagnose MI in patients with LBBB are:
Also check out the modified Sgarbossa Criteria from Dr. Smith's blog
Also check out this great summary from LITFL.
Should be easy to see the inferior MI, but don't miss extension to right ventricle dx by:
- In the presence of inferior MI
1) ST elevation in V1
2) ST elevation in lead III> II
3) ST elevation in V1 > V2
4) ST elevation V1 + St depression in V2 (highly specific for RV MI)
5) Isoelectric ST segment in V1 with marked ST depression in V2
In addition to the linked page also check out LIFL - RV Infarction
Our thanks to Dr. Tim Davie for assembling the Copa Cardiogram each week. Please follow this link to get to spreadsheet of all Copa Cardiograms.
Our favorite ECG Resources