Shoulder pain after lifting a heavy box

Written by Pendell Meyers, edits by Steve SmithThis will be too easy for most long-time readers, but if you are at that level, sit back and enjoy noticing how few milliseconds it takes to recognize this thanks to so many prior examples on this blog!I was sent this ECG from EMS with only the information that it belonged to a middle aged male with left shoulder pain.What do you think?There are hyperacute T-waves in leads V1-V6, as well as in leads II, III, aVF. The J-points are all at baseline with the exception of leads V2-V3 which show a small amount of STD (which makes de Winter morphology in the presence of hyperacute T-waves).How can you explain that the most obvious findings are in the anterior leads, yet the inferior leads are also hyperacute??The occluded vessel must supply the anterior wall and also the apex and/or inferior wall. The most common variant that satisfies this is a type III " wraparound " LAD. This is a large and long LAD that wraps around the apex of the heart, supplying the apex and sometimes even parts of the inferior wall.By ECG, this acute coronary occlusion is predicted to be of very short time duration, with very high acuity and very high viability. As shown in our reference diagram below, hyperacute T-waves generally exist only within a few hours of persistent acute coronary occlusion, or immediately after reperfusion ( " on the way up, and on the way down, " as Dr. Smith says).We activated the cath lab based on this EMS ECG, because it is obviousl...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs