Quiz post: do either or both of these patients have high lateral OMI / South African flag sign?

 Written by Pendell Meyers, edits by SmithTwo patients presented with acute chest pain/pressure. Here are their ECGs:Patient 1:Patient 2:See below for " answers " , and below that for both cases." Answers " : Patient 1 shows very subtle high lateral OMI, South African flag sign. She had an acute LAD OMI in the process of reperfusion, see case below.Patient 2 has a normal variant ECG which mimics high lateral OMI, and ruled out for MI, see case below.Here is theSouth African Flag sign (Figure by Ken Grauer — with the original 12-lead from Patient 1 attached below — See his Comment from theApril 8, 2022 post in Dr. Smith ' s ECG Blog for more on this sign).Patient 1:A woman in her 60s presented with 10 days of intermittent chest tightness. The pain occurs anywhere from once a day to multiple times a day, lasting 10-15 minutes before resolving. It occurs both at rest and with exertion. It most recently occurred at about 1600 this afternoon and lasted 15 minutes. She is reportedly pain free on arrival, when this ECG is obtained:Triage 1627Sinus rhythm, normal QRS (except poor R wave progression), perhaps the tiniest possible STE in aVL, tiny STE in V2, awkwardly straight ST segment morphology in I and aVL and V2, concern for increased area under the T waves in aVL, V2, with reciprocal STD and negative hyperacute T waves in III and aVF. All very very subtle.ECG read as: " Shows T wave inversions in the inferior leads and less than 1mm STE in V2, without STEMI criteri...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs