Here’s a video I made breaking down this very important #ECG pattern #FOAMed

Sam, I support you in sharing your interpretations on more of these “fan-submitted” tracings. Explaining the thought process is equally (if not more) important than sharing the correct ECG interpretation. Your videos are always exciting and highly educational!

Hi Robert. Yeah I came across this and knew it was gonna be too much to type into a tweet so thought I’d just make the quick video. I’ll have to consider doing this more. Thanks so much for your kind feedback!

Standardized, anonymized and digitized this beautiful tracing!

Thanks, by I tend to disagree with your conclusion. See this nice paper, 99 patients activated for cath because of aVR+, only 10% complete vessel occlusion, none LM or Prox LAD. I guess most important is to find the actual cause of STD > cath STAT.

Hi Alain, thanks for your comments. It’s critical to understand as I tried to make clear that this pattern does NOT represent Coronary Occlusion or “STEMI”, aka Transmural Ischemia. It’s usually not ACS but when it is—Cath ASAP (Urgent). I agree with the authors’ conclusions.

My cards trust me and will take this emergently for me, but you can tell they don’t really want to.

Brilliant explanation and spot on! Thank you for take the time to explain some of the nuances beyond “left main/proximal LAD. Cath lab.” Code Heart called within 10 min of ED arrival.

Beauty explanation… some of us practicing community medicine require the use of TNK still! Cath lab >4hrs away.

Yes absolutely and thanks for your kind words!

ST elevation in aVR I am always concerned of left main occlusion, first injection on the left is gentle and from outside the ostium of the left coronary artery.

Yes although the pattern itself does not represent “occlusion”—ie: plaque rupture with obstruction so high resulting in such little flow to cause transmural ischemia. There IS flow. But it can evolve to occlusion at any time (deadly!) so should be taken very seriously. 👊