Deadly heart attacks are more common on a Monday

Staffing tends to be lower on weekends AFAIK, could it be triggered by extra stress from not getting proper care during the weekend?

Another possible factor could be the fact that doctors tend to make more mistakes during operations on Fridays compared to start of week.

Not for a STEMI specifically, it’s one of two ECG patterns even a radiologist like me knows how to read. This is a stronger argument for other diseases. Door to balloon target in STEMI is 90 minutes.

STEMI centers (this is picked up by EMS and these ambulances are redirected to appropriate centers) have 24/7 cath lab coverage and any major one will have an ER bypass even during afterhours to expedite care.

In fact more and more hospitals (and all the major ones) announce a “Code STEMI” overhead either when the ambulance is dispatched or as soon as the ECG showing ST elevations is discovered in triage/ER to activate the team and reduce door-to-balloon time.

How common is it for a non-cardiologist know how to read ECGs? Is it something required in medical school? I heard a critique of Soviet medical training that nonspecialists didn’t know how to read them.

The basics definitely taught & required of all junior docs (UK) - but it's nuanced, not just a binary 'read an ECG correct or incorrect' - a specialist might spot something someone else doesn't; two specialists might disagree on whether it shows something or not. (And an interested (inherently non-specialist) junior might notice something a bored & rushed specialist doesn't.)

Seems like the perfect application for some kind of first pass (in the ambulance,even) automated ML diagnostic, given the data is 2D, well characterized, and mostly repeating.

Edit: aha--https://www.nature.com/articles/s41467-020-15432-4

Agree in general, even if one knew this at one point or know the textbook appearances patients don't read textbooks and there's nuance to everything. Unless you're actively exposed to/interpreting ECGs in clinical practice you lose the skill.

When I was an intern I was 100x better than I am at this point in my career.

The basic atrial fibrillation and STEMI is something any doctor can interpret with confidence (I used myself as an example as I'm probably the least competent because I haven't looked at an ECG in 10 years). I doubt non-cardiac surgeons are much better on average as they don't really look at these themselves that often other than for basic things.

An ER or general internal medicine physician is expected to be competent in more advanced but common stuff like bundle branch blocks, left ventricular hypertrophy, non ST elevated MI.

Weird arrhythmias or conduction abnormalities is really only for cardiologists, and even then typically a subspecialist electrophysiologist.

We've had computer-reads/AI on ECGs since I was a medical student. Really good at detecting normal, bad at everything else.

US/Can healthcare systems still pay a cardiologist a couple of bucks to "finalize" the interpretation whenever they get around to it. It's a bit ironic, someone could have an MI on Friday, get treated and discharged and we're still paying someone on the Monday to read 40 ECGs (note these would have been acutely interpreted by the cardiologist treating the patient, most places have rules against self-referrals so you can't formally interpret anything you order yourself).

My wife is a nurse, and they definitely learned how to read ECGs in nursing school, and she later worked in a cardiac ICU where she got additional training. She couldn't read a 12 lead and notice all the things that a cardiologist would, but for STEMIs and a few others she was trained to recognize them and call a code.

Your wife would be more skilled than the vast majority of surgeons and radiologists at this as she looks at rhythm strips them way more than we do, and none of these physicians would hesitate to admit this.

Honestly, when I have an ICU nurse providing procedural sedation for me I essentially just defer to their expertise on the rhythms and if they're worried I activate the mobile response team.

> Honestly, when I have an ICU nurse providing procedural sedation for me I essentially just defer to their expertise on the rhythms and if they're worried I activate the mobile response team.

That matches with my impression about a lot of things in her job. I'm always a little surprised when she talks about calling the doctor saying I need X, Y and Z and the doctor just being like cool I'll put in the order. Obviously, not all doctors are like that but it seems like the vast majority defer to the nurses in a lot of situations. This is completely different than the conception I had of healthcare before I met her.

I love working with ICU nurses. Generally speaking they are are very competent and very much respect their scope (both physicians and nurses overstepping is a recipe for disaster) so it's an incredibly healthy and collaborative relationship.

> I'm always a little surprised when she talks about calling the doctor saying I need X, Y and Z and the doctor just being like cool I'll put in the order.

This is the best part. A lot of decisions like sleeping aids, antipsychotics, antiemetics don't have evidence to choose from the various options so it's a bit of trial and error. An ICU nurse typically covers 1-2 patients and knows them very well, so if the recommend/ask for something it's usually the right decision and reduces the cognitive burden on the physician. We obviously still do a safety/sanity check but ballpark estimate I'd say I disagree or order something else < 5% of the time.

Similarly I'd say the proportion of bullshit overnight pages (e.g. I fondly remember a 4am call that a patient has leg cramps) I've received from ICU nurses are even less than that.

General ward nurses on the other hand... A very heterogeneous bunch with high turnover (worse in academia, at my last hospital average career length was ~2 years before they leave for greener pastures) so the relationship is very different.

Not that I don't appreciate them or their work, but far less trust in decision making and they need more oversight.

If you can’t read a critical ECG you failed medical school

any recommendations for a crash course in cardiology for the motivated learner? (randomly searching the internet being really inefficient for this type of targeted learning. motivated, as in, diagnosed with a significant coronary artery blockage.)

I'm not sure what you practice but that's far too dismissive. I passed med school just fine and maintain my ACLS certification as required. Am I calling an AV block or even a STEMI in real life? Absolutely not.

I maintain enough competence to know when it looks like it could be critical so I can call for help, but realistically that's happening anyway as soon as someone gets unstable as I haven't resuscitated someone in years.

I haven't looked at a real patient's ECG in probably 7 years now. If you were the patient, would you even want me to? I'd rather just do the smart and safe thing, call for help.

No subspecialist (or even specialist) can maintain competence in all areas of medicine, it's hard enough keeping up my general radiology skills. It's a good thing none of us practice in silos by definition.

The statement I made was if you can't read a critical ECG then you failed medical school.

You have basically agreed with me. I made no statements about subspecialisation or attempt to reconcile the breadth of medical knowledge that is required as you progress through medical training into consultant status with that original knowledge, or implied that we're expected to be able to definitively diagnose and manage a patient with a ECG that implies an imminent threat to life.

Frankly I think that everyone should still be able to recognise a STEMI - it's pretty characteristic; the more severe or subtle AV blocks definitely take some familiarity; but the bedrock principle of ACLS is calling for help, and medicine is certainly a team sport

Apologies, I misunderstood your point. I thought you were criticizing that I can't read every ECG pattern in ACLS (what I assumed you meant by critical).

All good!