Jul 14 - Diagnostic Criteria for Acute Myocardial Infarction

Dr Khan presented a talk today on an important topic to learn early in the year, particularly since ~ 1 in 50 will be missed and misdiagnosis of MI is a major source of malpractice suits for primary care docs.

The best way to learn ECG diagnosis is to practice, and the Beth Israel Deaconess Medical Center has an ECG learning site that is free to access and has tons of ECGs that can be viewed in either a quiz or learning mode - http://ecg.bidmc.harvard.edu/maven/mavenmain.asp

In addition to reviewing the UpToDate chapter, I highly recommend this NEJM review article on the topic from March 6, 2003, which covers basic diagnosis as well as diagnosis in the setting of left bundle branch block and RV MI.

And if you want to read deeper, this article from 1996 is the best study on ECG criteria that support a specific diagnosis of MI in the setting of LBBB.

24 Feb - Syncope, MI, and LBBB

     Todays case was a patient with a significant underlying seizure history (poorly controlled) who now presents with several episodes of loss of consciousness not associated with convulsions.  Echocardiography revealed a rare congenital malformation - cor triatriatum.  This was likely unrelated to the syncopal event.  It is condition where atrium is divided into two chambers by a septum, which can produce symptoms the functional equivalent of mitral stenosis.
     A brief case discussion focused on patients with chest pain and left bundle branch block.  Symptoms suggestive of cardiac ischemia with a new or unknown duration LBBB should be managed as ST elevation MIs.  In patients with old LBBB and chest pain, some features suggest the presence of MI:  1mm concordant ST elevation, 5mm discordant ST elevation, or 1mm ST depression in leads V1, V2, or V3.  This data came from a substudy of the landmark GUSTO trial that established the usefulness of TPA for treatment of acute MI.  You can expect a question about MI in setting of LBBB on boards.