HPI: A 71-year-old male is being transported to the ED for acute chest pain. The following prehospital EMS ECG is transmitted:
Case ECG
Before watching this week’s video, ask yourself these questions:
- What is the significance of the T wave abnormalities seen?
- Would you activate the cath lab?
- How would you manage this patient?
Take Home Points:
- Don’t trust the computer interpretation, even when it reads “normal”
- A computer interpretation of normal still requires you to review the ECG!
- Computers tend to be particularly poor at detecting early signs of ischemia, e.g.:
- Early reciprocal changes in aVL
- Hyperacute T waves
- PVC’s can sometimes reveal STEMI!
- If the first ECG is non-diagnostic in a symptomatic patient, get a repeat ECG!
Reference:
- Hughes KE, Lewis SM, Katz L, Jones J. Safety of Computer Interpretation of Normal Triage Electrocardiograms. Acad Emerg Med 2017;24(1):120–4. PMID: 27519772.
- Riley RF, Newby LK, Don CW, et al. Diagnostic time course, treatment, and in-hospital outcomes for patients with ST-segment elevation myocardial infarction presenting with nondiagnostic initial electrocardiogram: a report from the American Heart Association Mission: Lifeline program. American Heart Journal 2013;165(1):50–6. PMID: 23237133.
- Millard MA, Nagarajan V, Kohan LC, et al. Initial electrocardiogram as determinant of hospital course in ST elevation myocardial infarction. Ann Noninvasive Electrocardiol 2017;22(4).PMID: 28044391.
Kudos: Big thanks Dr. Doug Sward for sharing his case this week!
Notes: Questions for Amal? Email him at amalmattu@comcast.net or find him on Twitter @amalmattu.
