OMI Pattern
Results:
Earliest Evidence of Occlusion MI
Key Points ACS is dynamic. Coronary arteries can occlude, partially reperfuse, and re-occlude over minutes to hours, and the ECG can show these shifts before biomarkers do. The earliest actionable…
Early Reciprocal Changes: OMI Pattern
Key Points STEMI criteria alone miss some acute coronary occlusions, so look for subtle “occlusion clues,” not just traditional STEMI criteria cutoffs. Minor ST elevation under 1 mm paired with…
Hyperacute T Waves: OMI Pattern
Key Points: Complexity of ACS: Arteries can spontaneously reperfuse or re-occlude. Understanding early ECG patterns of early acute ischemia can help detect dynamic changes and prompt rapid interventions. ECG Pattern…
Terminal QRS Distortion: OMI Pattern
Key Points What it is: In V2 or V3, there is no S wave (the R does not descend below the PQ baseline) and no J wave (no notch/slur at…
STEMI (-) Occlusion MI: OMI Patterns
Key Points Traditional STEMI Criteria Alone Miss Acute Coronary Occlusion MI: Widely used but insufficiently sensitive or specific, many genuine occlusions (OMIs) do not meet strict STEMI criteria. Current Guidelines…
Occlusion MI: STEMI Criteria & Beyond
Key Points A STAT ECG is the most critical first test in suspected acute coronary syndrome (ACS). It allows for early recognition of acute coronary occlusion myocardial infarction (OMI), a…
Aslanger’s Pattern and the Limits of Traditional STEMI Criteria
A 76-year-old man presents to the emergency department with shortness of breath, severe weakness, diaphoresis, and confusion. The following ECG is obtained on arrival:
Aslanger Pattern: OMI Pattern
Key Points: STEMI Diagnosis and Contiguous Leads: While current guidelines typically require ST elevation (STE) in at least two contiguous leads for the diagnosis of STEMI, this practice is not…
Precordial Swirl: OMI Pattern
Key Points Definition: The precordial swirl sign refers to a rotational pattern of ST-segment abnormalities across the precordial leads, suggesting a dynamic and evolving occlusion myocardial infarction (OMI). It is…
ST Elevation in aVR with Diffuse ST Segment Depression: OMI Pattern
Key Points Pattern: ST elevation in aVR (≥1 mm), often with ST elevation in V1 and widespread ST depression (≥1 mm in ≥6 leads). Mechanism: Reflects global subendocardial ischemia, often…
ST Depression V1-V4: OMI Pattern
Key Points Most Missed STEMI: Isolated posterior MI is the most commonly missed occlusion MI due to the absence of ST elevation on standard 12-lead ECG. ECG Pattern of Posterior…
Subtle ST Segment Elevation: OMI Pattern
Key Points ACS Dynamics: Occluded arteries in ACS can spontaneously reperfuse and reocclude, making ECG findings variable. Limitations of Computer Interpretation: Subtle STE is often missed by computerized ECG interpretation;…
South African Flag Sign: OMI Pattern
Key Points Pattern Recognition: The South African Flag Sign is characterized by: ST-segment elevation (STE) in leads I, aVL, and V2. ST-segment depression in lead III. Subtle but visually distinctive…
New RBBB and LAFB in ACS: OMI Pattern
Key Points Pattern Recognition: New-onset Right Bundle Branch Block (RBBB) and Left Anterior Fascicular Block (LAFB) occurring together is a high-risk ECG finding. Often associated with proximal Left Anterior Descending…
Barcelona Criteria: OMI Pattern
Key Point Challenge in LBBB and RV Pacing: Both left bundle branch block (LBBB) and right ventricular (RV) paced rhythms alter ventricular depolarization and repolarization, making recognition of acute myocardial…
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