Head On Motor Vehicle Collision. ST depression. Myocardial Contusion?

A woman in her 40's was involved in a head-on motor vehicle collision.  EMS noted a facial droop. On arrival she was hypertensive but other vitals were normal.  She did complain of back and neck pain, chest pain, and SOB.  She also had a facial droop as noted by medics.  This droop was apparently new.An ECG was recorded:This shows diffuse ST depression (diffuse subendocardial ischemia) in leads I, II, aVF an V3 to V6, with reciprocal ST elevation in aVR and V1.  This is diagnostic of subendocardial ischemia or injury.  The ECG was repeated 36 minutes later:The findings are improvingIs this:1. Myocardial contusion? 2. Stress Cardiomyopathy? 3. ACS? 4. Type II (demand ischemia) from stable coronary disease with stress?She was found on CT to have a subacute middle cerebral infarct.  Other workup and imaging did not show any serious injuries.She was admitted and underwent serial troponins.  All were negative.  In fact, they were undetectable with the Abbott Architect (contemporary, sensitive, but NOT high sensitivity) troponin I.  Limit of detection (LOD) = 0.010 ng/mL.   All values were less than 0.010 ng/mL.An ECG was recorded the next AM:Finding are almost completely resolved, but there is residual ST depressionAn echocardiogram was normal with an EF of 82%.She underwent an adenosine nuclear stress test:"Myocardial perfusion imaging with pharmacologic vasodilatation demonstrated small to moderate size, mild to mo...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs