OMI Can be Diagnosed by " Pseudonormalization of ST Segments "

This post was written by Tarissa Lai, one of our outstanding EM residents at Hennepin County Medical Center, with comments by Steve Smith and Dan Lee.CaseA 30 something y.o. female with HTN, HLD, diabetes, ESRD on dialysis is brought in by EMS with sudden onset, left -sided chest pain for the past four hours.This is her pre-hospital ECG: This is her first ECG in the ED:What do you think?I interpreted this as normal sinus rhythm with LVH, but no significantly peaked T waves concerning for hyperkalemia. I did not appreciate any significant ST elevation.However, the prehospital ECG is more worrisome:the T-wave inversion in V5 and V6 is precededby ST Elevation. In LVH, T-wave inversion in leads V5 and V6 should be preceded by ST depression, orat least by an isoelectric ST segment.These look like ischemic ST segments and T-waves.More Clinical history:I first met her on an overnight shift while she was sleeping in a hallway bed. She was a difficult historian as she kept answering in one word replies before falling back asleep. The patient had gone to dialysis that day without any significant change in her regimen. While she was in her bed at home, she hadsudden onset of left sided chest pain that radiated to her shoulder. The painwas pleuritic, without nausea or diaphoresis. The nitro she took in the ambulance did not help. Her physical exam was remarkable for a young woman sleeping comfortably in bed, whose chest painwas easily reproduc...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs