Sunday, August 6, 2023

Lecture by Smith: Selected Cases of Occlusion MI (OMI), or not, on the ECG

This may be my best lecture yet.  I gave it virtually to the Kaiser group.

You can access it also on the "Lectures and Podcasts" link on the Banner above.


MY Comment, by KEN GRAUER, MD (8/6/2023):


Brilliant talk by Dr. Smith on the state of the art addressing the “need for OMI — and the fallacy of STEMI”. For skeptics (including cardiologists) — Any questions about “Who is Dr. Smith?” are compellingly answered by the several minute intro of his credentials and research in the field of acute ECG interpretation for suspected infarction — that I suspect are without parallel by anyone anywhere in the field of cardiology.
  • For those acquainted with Dr. Smith (and already convinced of his unsurpassed excellence in this area of emergency medicine) — the didactic portion of his talk begins at 2:10 of this hour-long video.

I believe it BEST to view this talk on a device that allows you to STOP the screen each time Dr. Smith shows a new ECG. Doing so allows you to put YOURSELF to the TEST (keeping in mind that all ECGs shown are from patients with chest pain suggestive of potential acute coronary disease)
  • So — FREEZE the picture of each ECG on the screen — FORCE yourself to commit to an answer. Then — listen to the story by Dr. Smith on specifics of the case.

NOTE: There are 2 reasons to watch this video while stopping to freeze the screen each time that a new tracing is shown: i) To hone your skill in making a “quick read” — in which you force yourself to commit to a diagnosis of OMI or no-OMI; — and — ii) To give yourself an extra moment to look at all 12 leads of each ECG — so that you can practice picking up abnormal findings in other leads that support your “quick diagnosis”.
  • I watched this entire video from start-to-finish — but you can just as easily divide this talk into as many segments as you like. Watching 5-to-10 minute segments at a time, is like taking in a “brief dose of Dr. Smith” on optimal recognition of OMI as often as you like.

FINAL Thought: Dr. Smith tells it as it is — Just the facts . . . The current STEMI paradigm that continues to be followed by all-too-many clinicians (including all-too-many cardiologists) is fallacious. It is based on faulty studies — and is dangerous to the health of acute chest pain patients whose ECGs do not manifest millimeter-based STEMI criteria. 
  • Extensive data in support of the OMI Paradigm are presented in this video by Dr. Smith — together with numerous ECG examples of negative-STEMI but postive-OMI tracings that need to be promptly recognized. This video reviews how to recognize these OMIs.

  • In my opinion — this hour-long video by Dr. Smith should be required viewing for all emergency care providers and for all cardiologists.

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