Tachycardia, Dehydration, and New ST Elevation in a 20-something, then a Surprise.

p.p1 {margin: 0.1px 0.0px 0.1px 0.6px; font: 10.0px Arial; color: #4d4d4d; background-color: #fefefe}A male in his early 20s presented intoxicated, with no CP or SOB. An ECG was obtained for tachycardia.First ECG:Sinus tachycardia at 150.There is inferior ST Elevation and Q-waves that appear to be Inferior STEMI.There is reciprocal ST depression in aVL.Is this STEMI?The patient was very dehydrated.The physicians were worried about STEMI, and so did a Point of Care Cardiac Ultrasound which showed IVC collapse and hyperdynamic function.The patient had a previous visit with dehydrationThere had been some, but less, STENot very similar to this one.There was another previous visit with dehydrationAlso not similarHe was given 2 liters of IV fluids. A 2nd ECG was recorded 1 hour later:Sinus tach at a rate of 120Heart rate and ST segments are almost normalized What do you see now?See below.Unexpectedly, there is every other beat pre-excitation. So the patient has WPW. This was never diagnosed before. But I don ' t think this explains his ST segments.Clinical course3 serial troponins were below the 99% level of 0.030 ng/mL, but not undetectable.K was 4.5 mEq/L.The patient was rehydrated and discharged.Comment:Why the PseudoSTEMI pattern?I don ' t know for certain, and this ECG sure looks like inferior STEMI. However, patients with STEMI generally do not have tachycardia unless they are in cardiogenic shock. If such is the case, the patient ...
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