Acute chest pain and ST Elevation. CT done to look for aortic dissection.....

Written byWilly FrickA 67 year old man with a history of hypertension presented with three days of chest pain radiating to his back. He had associated nausea, vomiting, and dyspnea.What do you think?This ECG together with these symptoms is certainly concerning for OMI, but the ECG is not fully diagnostic, and another consideration could be acute pericarditis. Mistaking OMI for pericarditis is a much more harmful error than the converse. Still, in the interest of studying the ECG, here are some findings that could support pericarditis:Absence of large T-waves (flat ST segments)Absence of any STD in aVL (which is seen in 99% of inferior OMIs).There is no reciprocal depression anywhere (except aVR and V1, the rightward facing leads).STE spanning from lead I (0 °) all the way to lead III (120°), i.e. diffuse.There is appreciable PR depression in a few leads (I, II, V4-6).There is Spodick ' s sign (downsloping TP segment) in a few leads (V3, V4).The STE has a more concave morphology (vs the more ischemic coved appearance).Ongoing pain despite terminal TWI in a few leads (II, aVF, V5, V6). If this were OMI, that should indicate reperfusion and improving pain.There is end QRS slurring in II, aVF, V6 (vs the more ischemic checkmark sign).The STE in II is greater than the STE in III.The rate is tachycardic, which is uncommon in OMI and common in pericarditis.There is also low voltage across the ECG.Important note: None of these findings proves pericardi...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs