A man in his 60s with acute chest pain

Sent by anonymous, written by Pendell MeyersA man in his 60s presented with acute chest pain with diaphoresis. He had received aspirin and nitroglycerin by EMS, with some improvement. His vitals were within normal limits. Here is his triage ECG:2045:What do you think?The ECG is subtle, but diagnostic of infero-posterior OMI. The QRS is normal, yet in aVL the normal upright small QRS complex is followed by in appropriately large-volume T wave inversion, which is reciprocal to the T waves in lead III, which are probably hyperacute if compared to available baseline. Corroborating this is the subtle ST depression in V2-V3 which is inappropriate for the normal QRS complex, and in the context of ACS, we have shown this is quite specific for posterior OMI. Together, these subtle findings support and confirm each other: inferoposterior OMI until proven otherwise.  I sent the ECG with no information to Dr. McLaren, who instantly replied: " RCA? " (he means, " inferoposterior OMI, so probably RCA occlusion? " ). I agree that the RCA would be the most likely in general supplying inferior and posterior walls. PM Cardio ' s OMI AI (currently in development) was shown the ECG with no information, and it diagnosed OMI with a confidence of 99.2463...%:A prior ECG was available:This ECG is normal, and thus confirms the concerns explained above.The ECG was incorrectly interpreted as no signs of ischemia.The initial high sensitivity troponin I returned at 1,684 ng/L (normal for m...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs