ECG Exercise 8 - Computer Labeled Normal

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

1. Don’t trust the computer. Interpret all your own ECGs.
2. Traditional STEMI criteria have limited sensitivity for occlusive MI so keep an eye out for subtle findings.

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More on ECGs labeled normal on FOAMed

ECGs falsely labeled normal | ECG Cases | EM Cases

ECG cases with computer interpretation errors falsely labeled normal, including occlusion, reperfusion, hyperkalemia, WPW, Brugada

emergencymedicinecases.com

Never Trust The ECG Computer Interpretation for Ischemia | ECG Cases | EM Cases

ECG Cases blog reviews 7 examples of ECGs of patients presenting to the ED with chest pain, who's ECG were read as normal. Acute ischemia, subtle occlusion, on EM Cases

emergencymedicinecases.com

This post is for education and not medical advice.