October 18, 2024, by Eric Tang MD
All of the following initial ECGs were interpreted as “normal” by the computer. Assuming the patient presents with chest pain, do you agree with the machine or could this be an occlusive MI?
Case 1
Computer interpretation: Normal sinus rhythm, normal ECG
Case 2
Computer interpretation: Normal sinus rhythm, normal ECG
Case 3
Computer interpretation: Sinus bradycardia, otherwise normal ECG
Case 4
Additional history: this ECG was taken when the patient was pain free
Computer interpretation: Sinus rhythm with occasional PVC, otherwise normal ECG
Case 5
Computer interpretation: Normal sinus rhythm, normal ECG
Case 6
Computer interpretation: Normal sinus rhythm, normal ECG
Case 7
Computer interpretation: Normal sinus rhythm, normal ECG
Case 8
Computer interpretation: Normal sinus rhythm, normal ECG
Case 9
Computer interpretation: Normal sinus rhythm, normal ECG
Case 11
Initial ECG
Computer interpretation: Sinus rhythm w/ first degree AV block, otherwise normal ECG
Case 12
Computer interpretation: Sinus tachycardia, otherwise normal ECG
Case 13
Computer interpretation: Normal sinus rhythm, normal ECG
Case 14
Computer interpretation: Normal sinus rhythm, normal ECG
Case 15
Computer interpretation: Normal sinus rhythm, normal ECG
Case 16
Computer interpretation: Normal sinus rhythm, normal ECG
Case 17
Computer interpretation: Normal sinus rhythm, normal ECG
Case 18
Computer interpretation: Normal sinus rhythm, normal ECG
Cases and ECGs were taken from:
McLaren JTT, Meyers HP, Smith SW, Chartier LB. Emergency department code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation a 7-year retrospective review. Acad Emerg Med 2024. (Link)
Take home points
- Don’t trust the computer. Interpret all your own ECGs.
- Traditional STEMI criteria have limited sensitivity for occlusive MI so keep an eye out for subtle findings.
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