2 ECGs texted to me. Minimal STE in inferior leads. How important is it?

These 2 ECGs were texted to me with the words " I think acute MI, but cardiology does not. "I believed these to be 2 serial ECGs:ECG 1: (later found to be time zero):Computer read: " minimal ST depression 0.025 mm "There is a small amount of STE in II, III, aVFFrom less than 0.5 mm - 0.5 mm.There is les than 0.5 mm of reciprocal ST depression in aVL, and an inverted T-waveAnd the other: (later found to be time 24 minutes):Now there is more STE and more STDOne very telling finding are the ST segments in V2-V6:ST depression has developed in V2-V6, downsloping in V4-V6.Though minimal, this is very specific adjunctive data for ECG diagnosis of MI.This was my response:" It looks like a myocardial infarction...Does the patient have chest pain? "History:Syncope in clinic, some vague chest pain.Not a great history, so we looked for a previous ECG:From within the last yearNo STE, no STD.This makes the others diagnostic.Cardiology had wanted the patient to be admitted, but had not seen evidence of acute MI and had not wanted the cath lab activated.In spite of this, my partner and I agreed the cath lab should be activated, so he did activate.Just before transport, another ECG was recorded at time 71 min, prior to cath:Now obvious inferior and posterior STEMI.The patient had a ventricular fibrillation arrest before the angiogram, and was resuscitated.Angiogram: 100% distal RCA occlusion.After cath, next day:Reperfusion T-wave in III.STE resolved.Peak trop 47.4 ng/mL (large MI)p.p1 {margi...

Source: Dr. Smith's ECG Blog - June 22, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs