30 yo woman with chest pain and a " normal ECG " by the computer, this one prehospital

This was sent by paramedics in the Northwest Ambulance Service in the UK. James Alameddine credits his partner, Gary Wilson.CaseA 30 year old woman complained of chest pain and called 911.She had a prehospital 12-lead ECG recorded:As you can see, the computer interpretation is " normal "What do you think?This very perceptive medic noticed that the T-wave in V4 is far too tall for the QRS. Very abnormal. But computers are not programmed to find all abnormalities, including many that are dangerous. This is this one.How about ST Elevation?There is (as the computer measures -- at the side) more than 1 mm of STE in V2 and V3, but not the 1.5 mm that would trigger " STEMI " in a woman.Thus, you have to decide if this STE is due to normal variant or due to ischemia. Normal Variant ST Elevation always has good R-wave progression, and here the R-wave in V4 is only 3 mm.If we use the3-variable formula, with STE60V3 = 2 mm, QTc = 413, and RAV4 = 3, the value returns at 25.8 which is clearly diagnostic of LAD occlusion.The 4-variable formula which includes the QRS amplitude in V2 turns out to be: 20.6 (most accurate cutoff is 18.2), so both formulas predict LAD occlusion.The T-waves in V4-V6 should never be taller than the R-wave and should even be farless tall.They should look like this:Here are some more examples of hyperacute T-waves in V4-V6:An elderly man with severe chest pressure......Ventricular Fibrillation, Resuscitation, and Hyperacute T-waves: What do...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs