A man in his 60s with dizziness, nausea, chest pain, and LBBB

Submitted and written by Parker Hambright MD, peer reviewed by Meyers, McLaren, Grauer, SmithA man in his late 60s called EMS for acute dizziness, nausea, vomiting, and chest pain shortly after beginning his morning exercise. The symptoms lasted for only about 15 minutes and then resolved spontaneously. He was brought to the ED and evaluated in less than one hour from onset of symptoms. His history included known CAD, HTN, HLD, prior MI with LAD stent, AAA repair, and reported dizziness/vertigo.Here are his EMS and ED triage ECGs (unclear whether symptoms still present or resolved at time of these ECGs, but it seems that symptoms were likely improved or resolved):EMS:ED triage (within 1 hour of onset of symptoms):Baseline ECG from 1 year ago:This baseline ECG shows a normal LBBB.Meyers interpretation: The EMS and triage ECGs above have suspicious, but not diagnostic, changes from the baseline ECG. The baseline ECG shows only minimal ST deviations in the limb leads, whereas the triage ECG shows greater ratios of STE in III and aVF and STD in I and aVL, with increased area under the T waves, compared to baseline. But the triage ECG does not have any of the modified Sgarbossa criteria. It is not diagnostic, but potentially suspicious for dynamic changes of the inferior leads signaling inferior OMI. I would not yet be certain from these ECGs alone, but I would certainly get more information including repeat ECGs to see if this concern is playing out.His initial high sensitivity t...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs