A 50 year old with chest pain? What is going on? By Emre Aslanger.

Posted by Emre Aslanger, our newest blog Editor. Emre is a distinguished cardiologist in Turkey, and has published widely on the ECG in OMI and other areas.Emre Aslanger Google Scholar ProfileA 50-year-old male with a 20 years ’ history of diabetes mellitus treated with metformin only presents with chest pain that started 20 minutes ago. The pain radiates to left inner arm and is now about to resolve. His admission ECG is given below.What do you think?You can click on it to make it larger, but let ' s make it a bit easier to see here:What do you think?(you can still click on it to make it larger)Although the wandering baseline makes it a bit hard to interpret, ST-segment depression in inferior leads are quite evident. This should immediately urge the interpreter to look at high lateral (lead I and aVF) and anterior leads for subtle ST-segment elevation. There seems to be a subtle ST-segment elevation in aVL, which can be easily overlooked if interpreted in isolation. The ST-segment elevation in V1-3 is also highly suspicious. Moreover there is ST-segment depression in V4-6. All indicate a proximal left anterior descending artery (LAD) occlusion myocardial infarction (OMI), which sadly does not meet ST-elevation myocardial infarction (STEMI) criteria.Despite this, the automated interpretation suggests acute STEMI!  If you were use the LAD-normal variant STE formula (which is not advised when there is ST depression, which make normal variant all but imposs...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs