OMI Information

Question 1

Inferior Wall Reciprocal

Answer 1

aVL is the only lead truly reciprocal to the inferior wall, as it is the only lead facing the superior part of the left ventricle

Question 2

OMI T Wave

Answer 2

There is no formal, universal definition of what represents a HATW, however it is recognised that the ratio of T wave amplitude to the preceding complex is of more significance than overall T wave size. HATWs are wider and generally more symmetric than normal T-waves

Question 3

Isolated Posterior MI

Answer 3

ST depression maximal in leads V1-4, without progression to V5-6, should be considered a posterior OMI until proven otherwise, even in the absence of ST elevation in leads V7-9

Question 4

aVR Elevation

Answer 4

Lead aVR was previously assumed to carry little diagnostic value, as it’s vector is directed away from left ventricular depolarisation. ST elevation > 1mm in lead aVR has been shown to be 80% sensitive and 93% specific for left main or triple vessel disease in patients with NSTEACS

Question 5

PE Sign

Answer 5

T-waves are inverted in precordial leads, if they are also inverted in lead III and V1, then pulmonary embolism is far more likely than ACS with Sinus Tach / Hypoxia

Question 6

Hyperkalemia

Answer 6

Killer B’s
Broad
Brady
Blocks
Bizarre

Question 7

Leads Q should never exist

Answer 7

V2, V3

Question 8

Hyperacute T Waves

Answer 8

Usually, the defining feature of hyperacute T waves is that they are abnormally fat and broad, as if being inflated with air from below, causing increased area under the curve of the ST-T waves. I teach that hyperacute T waves look like they are being inflated with air, while hyperkalemic T waves look like a tent being pitched with a pole.

Question 9

LAD Occlusion pattern “Precordial Swirl,”

Answer 9

STE in V1 and aVR, with reciprocal STD in V5 and V6.

Question 10

Sgarbossa

Answer 10

• Sgarbossa lbbb and paced (wide qrs)
  
  • > 5mm discordant 2 points
  • STD >1mm v1-V3 3 points
  • Concordant ste >1mm 5 points
  • Need 3 to qualify
• Left is down and right is up for bundle branch

Question 11

• Dewinter t waves

Answer 11

• Dewinter t waves
  
  • Upsloping st depression in v leads
• Ste avr >.5mm

Question 12

Wellens

Answer 12

• Wellens
  
  • Deeply inverted v2-3
  • Biphasic positive to negative
• Avr greater elevation than one mm than v1
  
  • Depression of v’s

Question 13

AvL Depression

Answer 13

• Avl depression with subtle inferior elevation
  
  • .5 depression is present in 97% of cases