30-something woman with a HEART score of zero, EDACS of 2, computer " Normal " ECG, and initial troponin < Limit of Detection

I was working in triage very late when a 30 yo previously completely healthy woman walked in with 30 minutes of central chest pressure.This ECG was recorded:The computer called it " Normal " except for " Possible right ventricular conduction delay "What do you think?I immediately recognized an inferior-posterior-lateral OMI.  There are hyperacute T-waves in II, III, and aVF.  They are too large, wide, fat, and bulky in comparison to the size of the QRS to be normal.  The degree of upward concavity is less than normal.  There is a downsloping ST segment in V2.  There are relatively large T-waves in V4-V6.  The patient was otherwise healthy, had no past history, and had never had chest discomfort before.I immediately activated the critical care team and walked the patient to the critical care area, our " Stabilization Room. "  The team was there and I showed them the ECG and said " I am 80% certain this is OMI.  Let ' s record another one. "So another was recorded 19 minutes after the first:This is diagnostic of inferior-posterior OMI.  There is dynamic change from the previous.We activated the cath lab.While waiting for the cath team, a 3rd ECG was recorded:Now there is STE in V6, with large T-waves in V4-V6.It may be difficult to appreciate the difference between V4-V6 between the 2nd and 3rd ECGs, so I put them side by side:                 &...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs