A 20-something with intermittent then acute chest pain

This was sent to me by a partner:" Curious what you think of this one we had overnight.  Healthy male under 25 years old with a pretty good story for acute onset crushing chest pain relieved with nitro.  He had another episode the day before after exerting himself.  No pericardial effusion on ultrasound. "What do you think?First, many on Twitter said " Pericarditis " .  This is NOT pericarditis, which virtually NEVER has ST depression any where except aVR.  When there is ST depression (as in aVL, V2, V3), then top on the differential is OMI or myocarditis.See our publication: ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditisThere is STE in inferior leads, high lateral leads, and V4-V6.  And there is ST depression in V2 and V3, all but diagnostic of posterior OMI.My response was: " OMI until proven otherwise "#PMCardio AI Bot (AKA: " The Queen of Hearts " ):OMIYou can sign up to be on a list to receive the PM Cardio AI App here.  It was trained by Drs. Smith and Meyers to diagnose both obvious (STEMI) and subtle OMI.The young age always makes one suspicious of myocarditis.  The STE in II ＞III is also suggestive of myocarditis.  But the stuttering pain and sudden onset suggest acute coronary occlusion (Occlusion MI, or OMI).  And it would be dangerous to assume this is myocarditis.  Therefore, emergent cath is indicated, and the cath lab was act...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs