A 60 year old with chest pain

A 60 year old with chest pain:what do you think?The medics came to me worried about hyperacute T-waves.  But these are not HATW and I immediately said so.  Why?The ST segment is too flat, resulting in a narrow base for the T-wave even though the QT interval is quite long (QTc Hodges = 464 and a lot longer by Bazett).  T-wave hyperacuteness is due to area under the curve, which is height + width + straightness of the ST segment.  The width of the T-wave is not determined only by the QT interval!  It is also determined by the ST segment itself.  A patient with hypocalcemia has a long ST segment and thus long QT, but not necessarily and wide T-wave.And here we see a long QT without a wide based T-wave; rather, it has a narrow base.HyperKalemia also has a narrow base.  Is this hyperK.  No.  Although therecould be a high K, there is no evidence of it on the ECG because the T-wave is rounded at the top.  You could sit on it without puncturing your behind.The patient ruled out for MI by troponins.  Potassium was normal.I sent this ECG to the Queen of Hearts (PMcardio OMI), and here is the verdict:===================================MY Comment, by KEN GRAUER, MD (7/10/2023):===================================Ruling out acute OMI in a patient with chest pain can be equally challenging as ruling it in. Today ' s case spotlights this challenge.While I was not 100% certain (given the history of ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs