The April 2025 case scenario for the chest pain MI registry will review sequence 12300 STEMI or STEMI-equivalent. A 56-year-old female presents via EMS for chest pain and tingling in the left arm. The EMS ECG reveals a 2-millimeter elevation and leads V1 and V2. She has a past medical history of anxiety and bipolar disorder with no known cardiovascular disease. The EMS alerts the hospital of the impending STEMI communicating symptoms and ECG transmission. The ED physician alerts the cardiologist of the impending STEMI. Per usual, the cardiologist orders an ECG to be obtained after the patient's arrival before making any plan of care decisions. It is well known to the ED staff that this cardiologist rarely, if ever, activates the cath lab staff based on communications from EMS. The ED ECG reveals a 2-millimeter elevation and lead 1 and V2, but given the patient's history of anxiety, the cath lab is not activated initially. The ED physician insists the patient should go to the cath lab based on symptoms and ECG findings. The repeat ED ECG reveals a 2-millimeter elevation in V1 and V2. The cath lab is activated 20 minutes after the patient arrives. A drug-eluting stent is successfully deployed to the culprit lesion for the STEMI clinical diagnosis. Our question is, how are the three ECGs coded in sequence 12-300, STEMI or STEMI equivalent? Number one, yes for the first ECG only. Number two, yes for the third ECG only. Number three, yes for the second and third ECGs. Or number four, yes for all three ECGs, the first, second, and the third. Please take a moment to review the documentation before making your final answer. The answer is number four, yes for all three ECGs, the first, the second, and the third. The rationale for answering this way, the subsequent ECGs have the same reading interpretation as the first ECG. Thus, it is confirmation of the first ECG's tracings. Without conflicting documentation, the ECG machine auto-generated reading or EMS personnel interpretations are used for data abstraction. In this scenario, it is noted, per usual, the cardiologist orders an ECG to be obtained after the patient's arrival before making any plan of care decisions. Early effort should be made to ensure timely reperfusion. This may require a root cause analysis. Questions to ask, why is the cardiologist requiring an additional ECG after arrival and before making any plan of care decisions? Is it a lack of confidence in the EMS ECG interpretation? If so, does the EMS personnel need education? Or if not, can a physician champion assess and assist? Time is muscle. The patient depends on the entire medical community to act as one unified team for their continuum of care. Thank you for viewing the Chest Pain MI Registry April 2025 case scenario.

fibromuscular dysplasia

coronary artery dissection

NSTEMI

STEMI

PCI

cardiologist

reperfusion

ECG

medical teamwork