ECG Exercise 1 - McCabe OMI Test

• This ECG shows an inferior wall (II, II, avF) MI with a reciprocal change in leads I and aVL. V1-V3 STD suggest posterior extension.

There is significant artifact. At first glance there may be III STE and avL STD but not consistent with every beat. Would recommend repeating.

There are inferior TWI / q waves with subtle STE (<1mm) with reciprocal STD in I and VL. This does not meet "classic" STEMI differential but this suggestive of occlusive MI.

This an ugly ECG. There is artifact and the rhythm is difficult to determine, but I'm not asking about the rhythm. There appears to be LBBB vs. IVCD with concordant STE in II, III, avF, V5-V6 and concordant STD in avL concerning for an inferolateral MI

STE in the inferior leads and reciprocal STD in I and Vl suggest inferior MI. There is also isolated STD in V2.

This ECG shows high voltage, diffuse ST/T-wave changes but this is likely secondary to abnormal repolarization from LVH rather than MI.

This ECG shows an inferior wall myocardial infarction with reciprocal changes in leads I and aVL.

There is subtle STE w/ TWI in avL with reciprocal STD in the inferior leads concerning for lateral MI.

There are hyperacute T waves in V2-V5 concerning for anterior MI.

This is a subtle lateral wall myocardial infarction. There is q wave + STE in avL with reciprocal STD in the inferior leads.

This ECG shows a lateral wall myocardial infarction (STE in V5-V6) without obvious reciprocal changes.There is subtle STD in V2-V3 that may indicate posterior involvement.

Tall R waves in V1-V3 with STD suggest posterior MI. Posterior MI rarely occur in isolation. There also appears to be hyperacute Ts in both the inferior and lateral leads.

There is is significant artificat. This appears to be early repolarization pattern. There are diffuse STE with notching appreciated in the inferolateral leads..

This ECG shows sinus tachycardia with RBBB/LAFB. STD w/ TWI are seen in V1-V2 which are typical of RBBB. This is not diagnostic of OMI.

There tall R waves in V1-V4 with STD suggestive of posterior MI. There is subtle STE in avL w/ STD in III which indicate lateral involvement. What is the rhythm? Complete heart block.

There STE in V1-V2. V2 has hyperacute T wave concerning for anteroseptal MI. There is subtle STE in avL with reciprocal inferior STD suggesting lateral extension.

This is a infero-posterior MI, with marked elevation (II, III, avF) and STD (avL, V1-V3). Tall R wave in V2-V3 with STD suggests posterior involvement. .

This is an anterior MI with lateral extension. There is STE w/ terminal qrs distortion in V2, and marked STE in V3. There are inferior STD and subtle avl STE suggesting lateral involvement.

This is an inferior-posterior MI. There are inferior STE (II, III, avF) with avL STD. There is tall R wave in V2-V3 with STD indicating posterior involvement. What's the rhythm? 2:1 2nd degree avb.

This an anterior MI with in a RBBB. There are typically STD and TWI in V1-V2 in a classic RBBB, but here there is marked STE in V1-V4. What's the rhythm? Afib. Is this unstable afib if the patient is having a heart attack? That's a discussion for another time.

"This ECG shows a subtle lateral wall myocardial infarction with obvious reciprocal inferior depression. The elevation in aVL may seem minimal, however, it cannot be ignored as “not meeting criteria” with such frank reciprocal changes present.”

If the patient had resolved chest pain, this ECG is concerning for Wellen's syndrome (anterior symmetrical TWI in the V1-V3). This is technically not a MI but concerning for impending MI. The original study had No as the answer but I will give credit for both answers.

There is STE in V1-V2 with tall R waves. P-pulmonole is also appreciated. Consider alternative diagnoses such as RVH / RV strain.

This ECG is concerning for anterior MI (STE in V2-V6, avR) with lateral extension. There are impressive reciprocal STD in the inferior leads.

This shows an anterolateral MI (STE in V2-V5, avL) with inferior STD. Of note there are PVCs which do show marked excessively discordant STE also concerning for MI.

This ECG is "non-ischemic”

This ECG shows marked bradycardia. The quality of ECG is poor. there are distinct J waves which in V4-V6 which may be from hypothermia but overall this is non-diagnostic of occlusive MI

There are deep symmetric TWI in V2-V4 and in the right clinical setting, this would be concerning for Welles syndrome. This patient did have chest pain that resolved and a cath that demonstrated critical stenosis of LAD. Since this is technically not a MI, will give credit for both answers.

There is avR STE with diffuse STD with asymmetric TWI. However no STE. MI is on the differential but this is not diagnostic of occlusive MI. What else can cause AVR STE with diffuse STD?

This ECG shows an extensive anterior wall MI (v2-V5 STE), without reciprocal changes. Note the convex morphology of the ST segments / T wave in V2-V4.

This not diagnostic of occlusive MI.

This ECG does show STD TWI in the anterolateral leads but in the setting of high voltage likely LVH. The TWI are asymmetric. This is likely LVH with repolarization abnormalities rather than acute occlusive MI.

This is a difficult ECG. At first glance there appears to be LVH with STE in V2-V5 likely from LVH (as these leads also have deep S waves). However there does appear to be subtle avl STE with lead III inferior STD. This patient ultimately had a negative cath. Will give credit for both answers.

This ECG shows sinus tachycardia with an acute anterior MI. The combination of tachycardia and occlusive MI may also point to acute heart failure / cardiogenic shock).

This ECG shows inferior STE with q wave in lead III and avL STD suggestive of inferior MI.

This shows an inferior (STE II, II, avF) and posterior (tall R wave with STD in V2-V3) with reciprocal STD in I, avL, V5. There is artifact and missing lead V6, but this is enough to diagnose MI.