A 37 year old woman with Chest Pain

I was sent this ECG with the following information:A 37 year old female with no comorbidities, a non-smoker, with no known hyperlipidemia and no family h/o of CAD presented to ED with central chest pain since 5 hours with no radiation, increased by moving her arms and associated with SOB.  This occurred after a stressful interpersonal conflict. She had had similar episodes before when angry or stressed.Her vital signs are BP 110/70, P 70/m, RR 18/m, O2 sat 98% RA.  Physical exam was normal. Here is the ECG:What do you think?Here was my response:"I looked at the ECG and immediately thought "This is an acute LAD occlusion."  It is diagnostic of LAD occlusion, but really only to someone who has expertise.  You will virtually never see an EKG like this that is a patient's baseline.  The T-waves are huge in proportion to the QRS, the QRS amplitude is very small, the T-waves are symmetric and fat, there are sagging ST segments in I, II, V3 and V4.  V3 should have some ST elevation, but it actaully has a bit of ST depression." These should be thought of as subtle de Winter's T-waves.Outcome:Labs shows normal cardiac enzymes and normal troponin. She was discharged with diclofenac 75 mg IM injection.  The pain was relieved. The patient was discharged home with reassurance and analgesia.12 hours later the patient was found collapsed at home with no signs of life.  The family refused a post-mortem.   As she visited ou...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs