Quiz The PM Cardio Queen of Hearts AI model for ECG interpretation from Powerful Medical is still in its early days.  Do you think you can outperform the toddler version of the AI model?  Version 2.0 will soon be available with four times the training data. The QoH groups ECGs into OMI and NOT OMI. Each category is subdivided into three levels of confidence.  Thus you can get a reading of NOT OMI (low, mid or high). Or you can get sa reading of OMI (low, mid or high).  In other words there are six outputs with NOT OMI high confidence on one end a ..read more

A 50-something male with hypertension and 20- to 40-year smoking history presented with 1 week of stuttering chest pain that is worse with exertion, which takes many minutes to resolve after resting and never occurs at rest.  It is associated with mild dyspnea on exertion.  At times the pain does go to his left neck.  It was present on arrival at triage but then resolved before bed placement in the ED. EKG from triage:   Here is his previous ECG: Normal ST Elevation Resident's interpretation: Reperfusion pattern/Wellens' with biphasic T waves in V2 and V3, and in ..read more

This was sent to me by an inpatient nurse who reads this blog but wants to remain anonymous. An inpatient rapid response was called for a patient with hypotension.   The patient was originally admitted for pneumonia and had been transferred out of the ICU a day prior. He had a history of HFrEF, HTN, and AML.  "When I arrived his blood pressure was 70s/40s and he was pale and profusely diaphoretic."  "He spoke Spanish but we did deduce that he had 7/10 chest pain radiating to the back."  "We couldn’t initially get a hold of the primary physician but our hospital allows ..read more

A 56 year old male with PMHx significant for hypertension had chest pain for several hours, then presented to the ED in the middle of the night. He reported chest pain that developed several hours prior to arrival and was 5/10 in intensity.  The pain was located in the mid to left chest and developed after riding his bike.   There was associated fatigue when symptoms developed and mild shortness of breath at onset of chest pain however that has since resolved.   The patient states he experienced similar 7/10 chest pain 2 days prior when he had to hurry to catch t ..read more

By Magnus Nossen This ECG is from a young man with no risk factors for CAD, he presented with chest pain. How would you assess this ECG? How confident are you in your assessment? What is your next step? Note: lead format is Cabrera I was sent this ECG in real time. The patient is a young adult male with chest pain. The chest pain was described as pressure like and radiation to both arms and the jaw. Symptoms were on and off. The pain was worse in the night and better when moving. The patient sought medical attention when the pain recurred for a second straight night accompanied by arm numbn ..read more

This case came from a friend whose sister was the patient. She knew I was interested in ECGs, so she took a photo of this one. A young woman presented with acute chest pain. This was her presenting ECG: What do you think? This is clearly Brugada phenotype.  There is downsloping ST Elevation in V1 and V2.  To an experienced interpreter, it is clearly not due to OMI.  And it is clearly Brugada phenotype. The conventional algorithm did not interpret Brugada.  In fact, it read: ** **ACUTE MI / STEMI ** ** The physicians caring for the patient activated the cath lab f ..read more

An elderly man collapsed. There was no bystander CPR.  Medics found him in ventricular fibrillation.  He was defibrillated, but they also noticed that he was being internally defibrillated and then found that he had an implantable ICD. He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED. Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines. Here is the initial ED ECG.   What do you think? Rhythm:  Residents asked me why it is not VT.  If you use caliper ..read more

Sent by anonymous, written by Pendell Meyers I received a text with this image and no other information: What do you think? I simply texted back:  "Definite posterior OMI." The person I was texting knows implicitly based on our experience together that I mean "Definite posterior OMI, assuming the patient's clinical presentation is consistent with ACS." The patient was a middle-aged female who had acute chest pain of approximately 6 hours duration. The pain was still active at the time of evaluation. Queen of Hearts: You can see that the Queen is most concerned wit ..read more

A 69 y.o. male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia.  Per EMS report, patient believes he has been in atrial fibrillation for 5 days, since coming down with flu-like illness with rhinorrhea, productive cough, SOB. Patient is on rivaroxaben, carvedilol, and dofetilide (to suppress atrial fib -- rhythm control).  He states that he maybe missed a dose or two during recent illness. On EMS ..read more

Sent by Tom Fiero, written by Pendell Meyers   A man in his 50s presented with acute shortness of breath. Unfortunately we do not have access to the patients presenting vital signs. Here is his ECG: Original image, suboptimal quality Quality improved with PM Cardio digitization The ECG is highly suggestive of acute right heart strain, with sinus tachycardia, S1Q3T3, and T wave inversions in anterior and inferior with morphology consistent with acute right heart strain. There is also STE in lead III with reciprocal depression in aVL and I, as well as some subendo ..read more