A 29 year old male with chest pain, ST Elevation, and very elevated troponin T

By Magnus NossenThis ECG is from a young man with no risk factors for CAD, he presented with chest pain. How would you assess this ECG? How confident are you in your assessment? What is your next step? Note: lead format is CabreraI was sent this ECG in real time. The patient is a young adult male with chest pain. The chest pain was described as pressure like and radiation to both arms and the jaw. Symptoms were on and off. The pain was worse in the night and better when moving. The patient sought medical attention when the pain recurred for a second straight night accompanied by arm numbness as well as radiating pain. The above ECG was recorded. It is easy to say pericarditis in such a case. (young male no risk factors and ST-elevation in several leads) As Dr. Smith has emphasized many times you diagnose pericarditis at your patient ' s and your own peril. The ST segment depression in V1 had me worried, the (inappropriately) almost isoelectric ST segment in V2 worried me even more. In conjunction with the inferior and lateral minimal ST elevation I felt I had to rule out inferoposterolateral OMI as the consequences can be catastrophic. I sent this out to our " EKG Nerdz " group and in spite of his usual warning, Dr. Smith texted back: " I am going to go out on a limb and say it is a fake. "  Dr. Smith ' s top 2 most important features for differentiating OMI from Pericarditis are 1) absence of reciprocal ST depression in any lead except aVR and 2) " flat "...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs