A middle-aged man with acute chest pain.

A 50-something male had onset of chest pain 1 hour prior to ED arrival.  It is constant, 9/10, left-sided CP that radiates into left arm and jaw. Endorses some associated SOB, but denies back pain, fever, cough, chills, leg swelling, or other new symptoms. Has never had this before. Takes metoprolol for HTN. Here is the triage ECG:What do you think?This was not identified as OMI by either the conventional algorithm nor the triage faculty physician.Smith: I think leads V3 and V4 are highly concerning, and all but diagnostic, for acute LAD occlusion.  I would activate the cath lab, or at least look for an old one and/or obtain serial ECGs.  I would use the Queen of Hearts (which and theLAD vs. Early Repol formula.You can see many examples of use of the Queen of Hearts AI Bot from PMCardioHERE; you can sign up to get itHERE.Case ContinuedThere was an old ECG available from 1.5 years prior, but I do not know if the triage physician (who is VERY busy) looked for it.  Here it is:These T-waves are far smaller, confirming that the above ECG is indeed due to LAD OMI.Let ' s look at them side by side:                Old ECG                      On presentation, with chest painNow you can easily see that the T-waves in V2-V5 are all much larger, both taller and " bulkier...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs