An athletic 30-something woman with acute substernal chest pressure

Post by Smith, with short article by Angie Lobo (https://twitter.com/ALoboMD), a third year intermal medicine resident at Abbott Northwestern Hospital CaseA 30-something woman with no past history, who is very fit and athletic, presented with 1.5 hours of substernal chest pressure.  It was non-radiating and without other associated symptoms except for nausea.  She had zero CAD risk factors.Here was her ECG at time zero:What do you think?There is ST elevation in V2 with large fat T-wave.  There is ST depression in II, III, and aVF, and V3 to V6.I saw this before any other information and knew immediately that it represented an LAD occlusion.  There is 1 mm of STE in lead V2.  This must be explained, and normally would be explained by " normal variant, " or " early repol. "  However, normal variant never has associated ST depression, and here we see ST depression in II, III, aVF and V3-V6.  Moreover, there are large, fat T-waves in V2 and V3.  The T-waves in V3-V6 are subtle " de Winter's " T-waves (ST depression followed by a large upright T-wave).The physicians told me that they " knew something was wrong " with the ECG, but couldn't express exactly what.The pain was resolving after nitroglycerine when this ECG was recorded at time 44 minutes:The ST depression is lessThe T-waves are smallerThe physicians did not notice this either. But this is what you are lookin...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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