A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without

Submitted by Nic Thompson, Written by Pendell Meyers, edits by Steve SmithThis is a long post, but well worth the read because it clearly delineates the difference in patient outcomes between advanced ECG interpretation and STEMI criteria!Dr. Thompson evaluated a male in his 40s with history of CAD s/p MI with PCI years ago, active smoking, HLD, HTN, who presented with chest discomfort and diaphoresis starting when the patient woke up a few hours prior to arrival. The pain waxed and waned until EMS arrived and gave him 325 mg aspirin en route, and had significant relief just prior to arrival. Here was his presentation ECG with approximately 2/10 discomfort and improving:What do you think?This ECG is not diagnostic of anything by itself. However, the morphology of lead aVL is slightly suspicious with a subtle down-up T-wave (terminal positivity) which suggests that perhaps there is reperfusion of the inferior wall. The T-waves in the inferior leads are neither definitively hyperacute nor clearly reperfusing. Thus, they are within normal limits if you don ' t have a prior for comparison. Remember that T-waves appear normal briefly between transitions from occlusion to reperfusion and vice versa.Dr. Thompson documented concern based on the patients history as well as suspicious ECG abnormalities including " broad T-waves II, III, aVF with subtle depression in aVL...High suspicion for acute coronary occlusion with some perfusion (probably 2/2 ASA en route). "Again, I would n...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs