STEMI-NSTEMI vs OMI-NOMI: A Paradigm Shift in ECG interpretation of MI

Many doctors are not aware that over the past few years, there has been a tectonic shift in the interpretation of ischaemic ECGs. So much so that the STEMI NSTEMI paradigm is already outdated and a new paradigm called OMI NOMI has come into play. And as a result, we will have to unlearn & relearn many aspects of ischaemic ECG interpretation.

In this video, I will also discuss the answers to the following questions.
- How to diagnose Acute Coronary Occlusion before the ST Elevation occurs on ECG?
- What is the OMI NOMI paradigm?
- How to identify subtle findings of ACS on ECGs?

If you find my video useful, please let me know in the comments - that will motivate me to create more videos. Also please like, share & subscribe to my YouTube channel. And don't forget to click on the bell icon.

@PracticalECGCourses

Timestamp
00:00 Introduction
00:36 STEMI & NSTEMI - Concepts
02:48 Is the STEMI NSTEMI paradigm serving its primary purpose?
05:13 Why is the STEMI NSTEMI paradigm failing us?
08:03 OMI NOMI paradigm
12:33 How can I diagnose Acute Coronary Occlusion before the ST elevates?
13:11 ECG 1
17:19 Learning Points from ECG 1
18:49 ECG 2
19:12 Take home message

Hi, My name is Obaid. I am an Emergency Physician working in the UK. Teaching ECGs is a passion of mine and I have been doing it for over 8 years now. My area of special interest is in teaching the concepts behind ECGs that we see in daily practice and demonstrating how to use these simple concepts to attain expert level ECG interpretation skills.

I conduct online ECG teaching courses which are targeted at senior A&E trainees & Consultants. The teaching in these sessions is aimed at enabling expert level ECG interpretation skills appropriate for an ED setting. These courses should also be appropriate for any other specialty, especially acute specialities as well.

Checkout my website at:

My other videos include:
The Most Dangerous Misinterpretation of an ECG in ED

Cardiac Axis & its relevance in ED?

Another Example of using Concept Based Approach to Interpret ECGs

Visual Mnemonic for causes of Syncope - What to look for on an ECG?

Struggling to remember Sgarbossa Criteria for LBBB ECGs? Learn the Concepts & latest Updates (2023)

[MukokiSwagga]

Dr Obaid, your ECG content is purely top shelf. Excellent work and please keep up the good work!

[debigdogk]

Awesome teaching, thank you and thank you ❤❤❤❤❤

[nishamanish]

Thank you Obaid!
That was great. Concise and so easy to understand! Always been a great fan of your teaching style. ECG being so intimidating you make it feel so easy to understand. Please keep up your great work !!! All the best !

[cutonad]

Excellent well explained ecg next level ❤

[PracticalECGCourses]

Hi folks,
I hope you found the video useful. If so, please share it with you collegues - I believe it will be useful across all grades of medical specialities.
If you would like more of such content, let me know.

Send me your responses regarding the 2nd ECG in the video
It has many findings, but there is a "clincher" which will give you the final diagnosis.
All the best.

[Ahdbfbfbeh]

I am Favoring OMI

V3 has no j wave or S wave so ST elevation there unlikely BER
Subtle depression in iii and AVF suggests reciprocal change and also maybe I see down up t wave pattern in iii and avf
V5 looks like a check mark.


Big aloha from hawaii! Thank you so much for your YouTube videos. Tremendous resource!

[vivekg]

Hello doc .
2 things come to my mind on the final ECG
1. Sinus rhythm with LVH and early repolarisation pattern
2. STEMI - ST elevation V2 to V6 with reciprocal changes in 3, avf

[ramsheenaomer]

Thank you so much sir...
Well explained class👍🏻

[neethuvenugopal]

Hi Dr Obaid...this whole concept is a new thing for me & I greatly appreciate your effor and time.
He would have to go to the cathlab as it looks like he has tall R waves with q waves which could be suggestive of HOCM.
Could you kindly put the answer for thr question.

[zuhairyassin]

if it was up to me every one goes to the cathlab case closed time is crucial in ACS patients

[hiiamtheclydicier]

Literally me in last ecg:
"THE BIG AHH T W-"'