A 50-Something Male with 2 hours of Chest discomfort

This ECG was texted to me in real time, but I did not notice the message until about an hour after it came. " 50 + yo. Concerning history, known CAD "Recorded 2 hours after pain onset:What do you think?This was my response:" This looks like a worrisome EKG. It looks like an Occlusion MI (OMI), but I am not 100% certain. But by now you must have a repeat ECG.  Can I see it? "Pendell Meyers had an identical response when I sent it to him.PM Cardio AI algorithm said " OMI with high confidence "Explanation: There is subtle ST Elevation in inferior leads, with a hyperacute T-wave in III, reciprocal STD in aVL with an inverted T-wave in aVL, as well as an inverted T-wave in V2, and up-sloping ST segments in V5,6 with a biphasic (up-down) T-wave.The first hs troponin I was barely detectable at 4 ng/L.He sent me an old one from 2 years prior:The STE is now known to be new.  This makes the first one diagnostic.There is some LVH vs. Benign T-wave inversion in V3-V6.A repeat ECG was recorded 80 minutes after the first, at 200 minutes after pain onset:There are dynamic changes.  Confirms that the first one is diagnostic.The cath lab was activated.  The interventionalist asked for another troponin, which shortly returned at 66 ng/L.Another ECG was recorded while waiting for the cath team (it was nighttime). This was at 140 minutes after presentation, or 260 minutes after pain onset:Similar to the 80 minutes ECG.Angiogram:Culprit for the patient ' s inferior E...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs