What do you think of this ECG?? Is this during pain, or after pain resolution? Also, see the CT image of the heart.

If you saw this ECG only knowing that it is an acute chest pain patient, what would be your interpretation?This is a trick question, as you will see below.  But you can make a diagnosis here, and Pendell and I do this all the time when reading ECGs from databases. I sent this to Pendell without any information at all, and he replied " Postero-lateral Reperfusion. "The T-waves in V2-V4appear hyperacute, suggesting LAD occlusion,BUT there is also T-wave inversion that is typical morphology forreperfusion in V5 and V6.Thus, one must think of reperfusion.  When there is reperfusion and there are large T-waves in V2 and V3 along with inverted T-waves in lateral leads, one must think of aposterolateral OMI that is reperfused.  These large T-wave are "Posterior Reperfusion T-waves: Wellens ' syndrome of the posterior wall. "Here is the case in total.  62 yo with severe (10/10) CP of 3.5 hours duration.  BP is 186/106.  The patient had this ECG recorded at 7 minutes after registration at triage as a walk-in (not by EMS):What do you think?This is diagnostic of posterolateral OMI.  There is ST depression maximal in V2-V4.  Contrary to popular knowledge, the T-wave need not be upright!! It can be upright, inverted, or biphasic (we proved this fact in this paper)  In V2, it is entirely inverted.  V5 and V6 have hyperacute T-waves.There was high suspicion of OMI, so patient was brought to critical care area and another ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs