Off and on chest pain for 24 hours in a 50s year old man

Submitted by Ali Khan MD and James Mantas MD, MS, written by Pendell MeyersA man in his 50s with history of diabetes, hypertension, and tobacco use presented to the ED with 24 hours of worsening left sided chest pain radiating to the back, characterized as squeezing and pinching, associated with shortness of breath. His pain was initially mild, then became severely worse several hours prior to presentation, but then eased off again and was minimal on arrival. There was no associated diaphoresis, nausea, vomiting, arm pain, jaw pain, syncope, lightheadedness or other acute symptoms.Initial vitals: Temp 36.7 C, BP 161/79, RR 16, HR 70, Pulse Ox 97%Initial ECG (during " minimal " pain):What do you think?Meyers: I was sent this ECG with zero clinical information (and without the prior ECG below), and at that time I said that I did not see evidence of OMI. Yet there is minimal STE in III, some STD in I and aVL, andterminal T wave inversion in III, suggesting some reperfusion and consistent with the resolution of most of the pain. I should have seen that this could be inferior OMI with current reperfusion. If I had the history or the prior ECG below, I may have arrived at that diagnosis.PM Cardio Queen of Hearts AI said " Not OMI - High Confidence " . She is not able to compare to prior ECGs (yet).Prior ECG on file:Normal ECG, showing that the features above are new.He was treated initially with 325mg of ASA and 0.4mg SL NTG.Bedside POCUS revealed inferior wall motion abnormality (...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs