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Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

Dr. Smith's ECG Blog

By Smith, peer-reviewed by Interventional Cardiologist Emre Aslanger Submitted by anonymous A 53 y.o. Compensatory enlargement was defined as being present when the total coronary arterial cross-sectional area at the stenotic site was greater than that at the proximal nonstenotic site. The pain radiated to both shoulders.

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SGEM#344: We Will…We Will Cath You – But should We After An OHCA Without ST Elevations?

The Skeptics' Guide to EM

He is interested and experienced in healthcare informatics, previously worked with ED-directed EMR design, and is involved in the New York City Health and Hospitals Healthcare Administration Scholars Program (HASP). Acute coronary syndrome (ACS) is responsible for the majority (60%) of all OHCAs in patients.

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See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

by Emre Aslanger Dr. Aslanger is our newest editorial member. Dr. Aslanger is also the author of the DIFFOCULT study: Emre K. Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction. He is an interventional cardiologist in Turkey.

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Physical Examination as a Helpful Aid in Decision-Making in Challenging ECGs

Dr. Smith's ECG Blog

This was contributed by Co-editor Emre Aslanger, an interventional cardiologist in Turkey. A recent angiogram report indicated a totally occluded left anterior descending artery (LAD) and right coronary artery (RCA), with 30-40% narrowings in the left circumflex artery (LCx). A peak troponin level of 70 ng/L was observed.

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Proportionality is a major element in the ECG Diagnosis of OMI.

Dr. Smith's ECG Blog

I published, and Emre Aslanger externally validated, the 4-Variable formula for differentiating the ST Elevation of LAD OMI from Normal ST Elevation. Knowing the patient has a history of coronary disease could be relevant to today's case — as it should add to our suspicion of a new acute event.

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OMI-NOMI paradigm established as better than STEMI-NSTEMI with new article

Dr. Smith's ECG Blog

Their OMI Manifesto details how use of standard STEMI criteria results in an unacceptable level of inaccuracy, in which an estimated 25-30% of acute coronary occlusions are missed! The more leads in a given lead area that show hyperacute changes — the greater the concern for acute OMI.

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Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronary artery disease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy. Such cases are classified as MINOCA (Myocardial Infarction with Non-Obstructed Coronary Arteries). V1 has 0.5 mm of elevation.