A 40 year old man with chest pain since last night

Written and submitted by Ashley Mogul, with edits by Pendell Meyers and Steve SmithA man in his 40s with recent smoking cessation but otherwise no known past medical history presented due to chest pain since the previous evening. The pain has been constant and associated with vomiting and diaphoresis. He decided to present the following day when the pain had not stopped.Here is the presenting ECG (no prior available):What do you think?Relevant findings include slight STE in V1 with an upright T-wave, slightly large T-waves in V2-3 (possibly hyperacute if compared to baseline), and slight reciprocal depression in II, III, aVF, V4-V6.Meyers: This ECG was texted to me with no clinical information, and my response was: " That looks like a very subtle LAD OMI. If clinical picture was anything compatible with ACS I would heart alert it [Ashley and I trained at Stony Brook where we call a " Heart Alert " on a situation/ECG that doesn ' t meet STEMI criteria but we are nevertheless worried about the need for emergent cath and emergent ACS workup] and get serial ECGs, unless I had access to an identical baseline (not likely in my opinion). Very very subtle one. What happened? "These findings are very subtle but suspicious for LAD occlusion, as we have seen in many similar (but less difficult) cases on this blog:A man in his sixties with chest pain at midnight with undetectable troponinHow long would you like to wait for your Occlusion MI to show a STEMI? Sometimes serial ECGs minimize...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs