Chest Pain Physiology STEMI 
Dr. Smith's ECG Blog
JUNE 5, 2023
A 40-something male presented by ambulance with one hour of chest pain that was improving after sublingual nitroglycerine and 325 mg of aspirin, chewed. Here it is: Obvious Inferior Posterior STEMI (+) OMI. Initial troponin was: 3 ng/L We showed that the first troponin in acute STEMI is often negative in at least 27%.
Dr. Smith's ECG Blog
FEBRUARY 6, 2023
Sent by anonymous, written by Pendell Meyers A man in his 60s presented with acute chest pain with diaphoresis. Diagnosis: Acute non-ST segment elevation MI (Non-STEMI, or NSTEMI) Second troponin returned at around 0200: 15,894 ng/L 0245 (unclear if ongoing pain or not) Inferoposterior (and lateral V5-6) reperfusion findings.
Dr. Smith's ECG Blog
MARCH 15, 2021
An 80-something year old man with history of metastatic cancer had acute onset of chest pain and called 911. The computer read Anterior STEMI along with RBBB. There is no typical evolution of MI (so BOTH EKG evolution, and troponin, proves there was no acute MI) 2 weeks later, the patient present with acute chest pain again.
Dr. Smith's ECG Blog
OCTOBER 13, 2022
Written by Jesse McLaren, with edits from Smith and Grauer A 60 year old with no past medical history presented with two hours of chest pain radiating to the left arm, with normal vitals. But it doesn’t meet STEMI criteria, and was not identified by the computer or the over-reading cardiologist. What do you think?
Dr. Smith's ECG Blog
OCTOBER 1, 2023
A man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. He had active chest pain at the time of triage at 0137 at night, with this triage ECG: What do you think? Chest x-ray was normal. Respect physiology.
Dr. Smith's ECG Blog
APRIL 20, 2019
Written by Pendell Meyers An elderly woman presented with acute onset chest pain and shortness of breath. There is sinus rhythm with minimal STE in V1-V3, not meeting STEMI criteria. The delay between OMI and STEMI sometimes causes unacceptable loss of myocardium or worse.
Dr. Smith's ECG Blog
AUGUST 4, 2024
QOH versions 1 and 2 both say Not OMI, with high confidence, without any clinical context, despite the abnormal STE meeting STEMI criteria. Context: a man in his 40s presented to the emergency department with 1 day of sudden onset chest pain. I sent this to our group without information and Dr. Smith responded: "Not OMI.
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