A man in his 50s with acute chest pain and LVH

Sent by Drew Williams, written by Pendell MeyersA man in his 50s with history of hypertension was standing at the bus stop when he developed sudden onset severe pressure-like chest pain radiating to his neck and right arm, associated with dyspnea, diaphoresis, and presyncope. EMS arrived and administered aspirin and nitroglycerin. He reported several weeks of intermittent chest pain similar to the active pain, worsening over the past 2-3 days, some of them as long as an hour, but all spontaneously resolved and were of less intensity than the current symptoms.There are 2 very instructive posts which we link to at the bottom. Do not miss them!Here are his three EMS ECGs:EMS1 at 0735This was sent to Dr. Smith with no other information.  What did he say?Meyers sent this ECG to Smith without any other info and this was the response:Smith interpretation:" A very rare anterior OMI w high S-wave voltage. " Meyers: " I said I would have to say OMI until proven otherwise. But I was not certain. The inferior reciprocal part was the most helpful for me.  Steve, tell me more about how you know this one. The LVH makes it hard. "Smith: " I would not say Iknow it. But I highly suspect it due to the hyperacute T wave in V3, but especially, as you say, the inferior reciprocal ST depression, with ST elevation in aVL. "Another ECG was recorded: EMS2 at 0746EMS3 at 0755Baseline (4 months ago) (not available to EMS at that time)The three EMS ECGs above show initially concerning...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs