A man in his late 30s with acute chest pain and ST elevation

Sent by Dan Singer MD, written by Meyers, edits by SmithA man in his late 30s presented with acute chest pain and normal vitals except tachycardia at about 115 bpm. Here is his triage ECG:What do you think?Dr. Singer sent this to me with just the information: " ~40 year old with acute chest pain " . I immediately responded: " cool fake! Not OMI. Do you have a prior? There is a reasonable chance of pericarditis in this case, or this could be a baseline. " It could easily be mistaken for a South African flag pattern anterolateral OMI, with STE in I, aVL, V2. But importantly there is no reciprocal STD in III (which would usually be expected if the STE in aVL were indicative of acute transmural infarction). Additionally, there are prominent remarkable J waves in I and aVL. The significant STD in aVR belies a significantly diffuse STE vector which is maximal in the leftward and downward directions.No prior ECG was available.Here is the Queen of Heart ' s interpretation:The cath lab had been activated for concern of STEMI.I do not have much clinical detail available, but cardiology cancelled the cath lab activation for some combination of reasons.Three serial high sensitivity troponins were all below the limit of detection. Formal echo showed normal function, no WMA, and no effusion.No angiogram was performed.AMI was ruled out, therefore OMI is ruled out.Other outcome information is not available. Sadly, I did not receive enough information to adjudicate whether this pati...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs