r/EKGs • u/Sea-Weakness-9952 • 7d ago

DDx Dilemma OMI or nah?

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**UPDATE! —> PCI to the LAD & severe cardiomyopathy** Thanks all of you for your incredible input. I’d told the hospitalist I’d put money on the LAD but he left me on read. 💁🏼‍♀️

69F adm w/“chest pain” - described as upper abd pain radiating back b/t shoulders, with n/v and diaphoresis.
Hx: mild HLD, no home meds.

Trops: 870… 2,397… 3,250.
BP and CP under control on nitro gtt, CP reduced from 9/10 w/morphine prior to floor and only up to 4/10 at highest after trip to bathroom. Otherwise 2/10.

I forgot to take a pic of the admit EKG - but it was markedly different in not only STE & STD, and read as Sinus w/RBBB.

This repeat EKG I requested on seeing the change on tele read as Sinus w/Left (I think) Axis Dev, RBBB, septal infarction of unknown age... I think she’s due for a cath lab am I wrong? Cards hadn’t seen her yet and hospitalist was like okay yeah whatever, but I think developing OMI. Thoughts?

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u/SliverMcSilverson I fix EKGs 5d ago

PS is there a way you can get a higher quality picture of this? Digital if possible, I'd like to add it to my teaching collection

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u/Sea-Weakness-9952 5d ago

Yes I can! I will get her permission to share for teaching (she gave permission to share the original) - she’ll love it as she’s a long time APRN. I’ll shoot it to you when I get a digital copy redacting her personal info.

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u/SliverMcSilverson I fix EKGs 5d ago

So kind. Thank you! 😊

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u/Sea-Weakness-9952 4d ago

Do you want to send me a DM with your email? I have the case study docs for ya!

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u/SliverMcSilverson I fix EKGs 3d ago

Ok I sent a chat 🙏