STAT ECG Diagnoses: the ECG in patients with significant left ventricular hypertrophy (LVH) and how to identify occlusion MI in these patients (part 2/2)

Baltimore City EMS Cases with Dr. Amal Mattu


 LVH with strain pattern may mimic anterior coronary occlusion and is known to be a common cause of “false-positive” cath lab activations. The following prehospital ECGs were obtained in patients with LVH being transported to the ED with chest pain:

All these cases have evidence of LVH with strain pattern, a couple were also found to have acute coronary occlusion. Before watching the video, look closely at these 5 ECGs and ask yourself:

  1. How can we accurately diagnose STEMI in patients with LVH with strain pattern?
  2. For which of these prehospital ECGs would you activate the cath lab?