A 50-something with chest pain and minimal precordial ST elevation

A 50-something with diabetes presented with 3 hours of sharp chest pain radiating to the left hand, with dyspnea and diaphoresis; it was worse with exertion and with lying flat.He had this second ECG, which was texted to me and I looked at it on my iPhone. At the time of this ECG, the patient had received NTG and the pain was decreasing.ECG-1:There is 1 mm of ST elevation at the J-point in both V2 and V3 (within normal limits).Computer interpretation is normalCardiologist overread is normalWhat do you think?More description: There is also poor R wave progression, with small R waves in V4. The T waves are slightly broad and large, but probably could not be called hyperacute. There is minimal STD in aVF.One of our interns had texted this ECG-1 to me, with the message:" 3 hours of chest pain, QTc = 415 ms, 3 variable formula is25.3. What do you think? "__________[The 3-variable formula for differentiating normal variant ST elevation from the ST elevation of subtle LAD occlusion can be accessed by clicking on the link at the top of the page and entering the values into the online excel applet. Values are: 1. ST elevation at 60 ms after the J-point in lead V3. 2. R-wave amplitude in V4. 3. computerized QTc. See also the free iPhone app " SubtleSTEMI " . See alsoMDcalc.]A value greater than 23.4 is very worrisome for LAD occlusion.__________I responded: " Not LAD occlusion. What do you think? Do the 4-variable formula. " (...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs