This patient did not present with chest pain

This was posted a few years ago.  I ' m highlighting it again, with comments from Ken Grauer below.This was sent to me by Jason Winter.  @JasonWinterECGThis is a 36 yo m with h/o TBI and epilepsy. He had a seizure this morning and rolled out of bed unable to get up.  There were no injuries and no chest pain and he appeared well. He complained of 3 days of diarrhea and abdominal pain. The medics recorded a prehospital ECG: The computerized QTc is 397 msJason writes: "What ' s your thoughts Steve? "Jason was very skeptical of STEMI.What do you think?Jason,I agree.V4 especially looks like early repolarization. There is high R-wave voltage.The formula for differentiating LAD occlusion from early repolarization requires ST elevation at 60 ms after the J-point (here 5 mm), computerized QTc, R-wave amplitude in V4, and total QRS amplitude in V2. Unfortunately, the R-wave is cut off on this ECG but it appears as if it would be at least 20 mm.  Thus:The QTcB = 397.  The QRS in V2 = 18 mm.  The R-wave amplitude in V4 = 20.  STE at 60 ms after the J-point in lead V3 = 5.Formula value (see MDCalc.com) =17.9, which is below the most accurate cutpoint of 18.2 (but does NOT rule out MI by itself, only makes it less likely).See here for instructions on how to use the 4-variable formula to differentiate acute LAD OMI from benign variant STE in leads V2-V4.Note: In our study, we excluded from an...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs