Chest pain and T wave inversion, NSTEMI?

Case submitted and written by Dr. Mazen El-Baba and Dr. Emily Austin, with edits from Jesse McLarenA 50 year-old patient presented to the Emergency Department with sudden onset chest pain that began 14-hours ago. The nurse alerted the MD because the patient was still symptomatic, diaphoretic and “looking unwell”. What do you think?      ECG interpretation: sinus rhythm, normal conduction (PR, QRS, and QTc), normal axis, delayed R-wave progression, and normal voltages. There ’s primary TWI inferiorly (aVF and III) and V6, with reciprocal tall T-wave in lead I/aVL, and a Q wave in III. There’s also a taller T wave in V2, which can be reciprocal to posterior TWI.(1) This ECG represents reperfused inferoposterior occlusion MI (likely from the RCA) but could also be see n in subacute and ongoing occlusion.This doesn ’t meet STEMI criteria so in the current paradigm there’s no urgency to getting an angiogram. But two features were concerning: An ECG showing reperfusion indicates high risk for reocclusion – either from a transiently open artery at risk of closing, or an artery that is still occluded but with perfusion tenuously maintained by collateral circulationThe patient had ongoing ischemic symptoms, suggesting ongoing occlusion. Even though they were passed the 12 hour mark traditionally associated with reperfusion benefits, ongoing ischemia requires emergent angiogram On assessment, the patient appeared uncomfortable, lean...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs