A completely healthy 30-something woman with acute chest pain -- this post is loaded with info !!!

p.p1 {margin: 0.1px 0.0px 0.1px 0.2px; font: 11.0px Helvetica}A previously healthy young woman presented to the ED with one hour of acute onset right sided chest pain and pressure, very severe, radiating down the right arm.  Here is her initial ED ECG (time 0):What do you think?My impression:without any other information, I looked at this ECG and 2 features stood out: 1) the T-wave in lead I is hyperacute.  It is far too large for that QRS.  2) The T-wave in V6 is far too large; it is almost as tall as the R-wave, which is distinctly abnormal.  3) there is slight downsloping ST depression in V2 which is classic for ischemia/posterior MI.  There is also a slight bit of ST depression in V3.There is also some right axis deviation (S greater than R in lead I)See this post: Ten cases of hyperacute T-waves in V4-V6This is an Occlusion Myocardial Infarction (OMI) until proven otherwise.I am not sure this was seen.  She was given aspirin.  A bedside ultrasound was done.  Here is the parasternal short axis view:This is difficult to interpret, but I believe it is consistent with the ECG: To my eye, it shows a lateral (on the right) wall motion abnormality.I ' m not sure this was seen, and some may dispute the ultrasound interpretation.The patient ' s pain persisted.The initial troponin drawn on arrival returned one hour after the ECG.  It was slightly elevated at 0.048 ng/mL (URL = 0.030 ng/mL)NTG sublingual was given and a repeat ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs