Acute OMI or " Benign " Early Repolarization?

Written by Willy FrickA man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. He described it as severe, sharp, and substernal with associated nausea, vomiting, chills, and diaphoresis. The following ECG was obtained. Note that the machine read is" normal sinus rhythm, normal ECG. " Cardiology over read the tracing and signed the interpretation without modification.ECG 1What do you think?The Queen of Hearts sees no OMI but only with low confidence. She seems concerned about a few leads.I sent this ECG to Dr. Smith and Dr. Meyers with no clinical context. Dr. Smith said " That is a tough one. I would say OMI low confidence. " Dr. Meyers noted the presence of South African Flag sign, indicative of high lateral OMI.Smith comment: in clinical context, (middle aged with acute chest pain), the ECG is diagnostic and the cath lab should be activated.The patient was given aspirin 324 mg PO, nitroglycerin 0.4 mg SL, and morphine 2 mg IV all simultaneously. Twenty minutes later, his pain was unchanged and he was given an additional dose of morphine 2 mg IV. Thirty minutes later he reported significant improvement in his chest pain.Cardiac troponin I drawn around that time resulted at 0.323 ng/mL (ref.<0.049 ng/mL).Smith comment:thi...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs