RPM Lecture – EKG patterns you may be missing

ECG patterns you may be missing
Lecture from RPM 2019
Andrew Merelman
Twitter: @amerelman
amerelman@gmail.com

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Subtle anterior MI evolving over less than 3 minutes
LAD Occlusion

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Initial EKG demonstrates subtle anterior MI but was called “normal” by the computer
EKG 90 seconds later shows evolution of MI
LAD Occlusion

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Subtle inferior MI with evolvement
Always look for ST depression and T-wave inversion in aVL, can present BEFORE changes in lead III
RCA Occlusion

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Initial EKG showing  de Winter T-waves in leads V2-V5 indicating unstable LAD lesion
Resolution in second EKG after nitroglycerin, still requires cath lab
Patient had severe LAD stenosis and other lesions requiring CABG

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Additional example of DeWinter’s T-waves

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Initial EKG shows ST depression in V2-V5 indicating posterior MI
Second EKG shows evolving inferior and lateral MI
The posterior descending artery may arise off the RCA or LCx
This case was due to a LCx occlusion

 

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EKG demonstrating OMI in the setting of LBBB
Use the Modified Sgarbossa Criteria to detect MI in LBBB

Sgarbossa Criteria

 

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EKG with diffuse ST elevation
This can be mistaken for pericarditis but is actually due to occlusion of a wraparound LAD
Pericarditis is a diagnosis of exclusion, all other life-threatening causes must be ruled out

 

Most ECGs used (besides de Winter case) are from Dr. Smith’s ECG Blog with permission:
http://hqmeded-ecg.blogspot.com
OMI lecture: https://emcrit.org/emcrit/emcrit-podcast-250-the-omi-manifesto-lecture-by-pendell-meyers/
OMI Manifesto: https://emcrit.org/emcrit/omi-manifesto/

Highly recommend these resources:
“EKG Club” and “12 lead ecg. I’ve got the rhythm” groups on Facebook
http://www.ems12-lead.com