Keywords: ECG, EKG, electrocardiogram, electrocardiography, acute coronary syndrome (PubMed Search)
[Pearl provided by Dr. Semhar Tewelde]
Who are the experts at deciphering ECG's
Authors looked at 240 ECGs which activated the cath lab activation for STEMI. They excluded patients with LBBB or paced rhythms. Retrospective chart reviews were used to determine if there was actually a STEMI. The ECGs were then shown to 7 experienced interventional cardiologists and interpreted for acute STEMI.
Of 84 subjects, there were 40 patients with a true STEMI and 44 without (13 of whom had NSTEMI) Recommendations for immediate PCI varied widely, from 33%-75%. Sensitivities were 53%-83%, specificities 32%-86%, PPV 52%-79%, and NPV 67%-79%. When the cardiologist chose non-ischemic ST elevation, LVH was thought to be the cause in 6% to 31% and old MI/aneurysm in 10% to 26%.
Moral, even cardiologists can be wrong... EM physicians must scrutinize every ECG and challenge ourselves to be the best at interpreting ECG's.
Reference:Tran V, Huang HD, Diez JG, et al. Differentiating ST-elevationmyocardial infarction from nonischemic ST-elevation in patients with chestpain. Am J Cardiol 2011;108(8):1096-101.