Sometimes even STEMI is not enough

Written by Emre AslangerA 50 something-year-old man with a history of newly diagnosed hypertension and diabetes, for which he did not take any medication, presented a non-PCI-capable center with a vague, but central chest pain. His vitals were normal and his first ECG was as shown below:There is obvious ST segment elevation (STE) in anterior leads. STE in lead I and II are more subtle. The presence of J notch in V6 might have deceived the physician into thinking of early repolarization, but this can also be seen in anterior OMI. Note that QRS amplitudes are somewhat lower than expected and there is poor R wave progression. Add to these the slight reciprocal ST depression in lead III and aVF.   There are tall and peaked T waves in anterior leads. Hyperacute T waves are generally described as such in many textbooks, but actually the majority of hyperacute T waves are “bulky” rather than being “peaked”, this is an example just happens to be both. Also not only the bulk of the T wave does matter, but also its proportion to the corresponding QRS complex is important. You can find many examples on this blog attesting that. Here, for example, T waves in lead II and aVF looks out of proportion to their respective QRS complexes in isolation. Is this a subtle ECG ? I am sure that it is not for the readers of this blog. But I frequently witness that the diagnosis of OMI, especially anterior OMI, becomes much harder when there is no clear (although we have sub...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs