A man in his 30s with chest pain

Written by Pendell Meyers, submitted by Siva Vittozzi-WongA man in his 30s with history of hypertension, hyperlipidemia, and diabetes presented with chest pain which started 12 hours prior to presentation. The pain was described as pressure, constant for 12 hours, radiating to the jaw, with left arm numbness. Initial vitals were significant for bradycardia at 45 beats per minute.Here is his presenting ECG with active pain:What do you think?Here was the prior EKG on file:The emergency medicine resident (who has received lectures from me on hyperacute T-waves, suble OMI, etc) documented the following interpretation:" Initial EKG showed hyperacute T-waves in the inferior leads, in particular lead III. These findings are suggestive of an RCA occlusion which is supported by bradycardia due to SA node ischemia. Compared to an old EKG on file, these are all new findings. "Meyers comment: So proud. Spot on. Inferior hyperacute T-waves, with negative hyperacute T-wave in aVL. The lateral leads also have minimal STE and hyperacute T-waves. Even without having the baseline ECG, I would say the inferior hyperacute T-waves are still diagnostic. With the baseline ECG in hand, it is all much easier and much more diagnostic, and you can see that the lateral leads are clearly hyperacute as well. Of note, the inferior leads may actually have STE that just barely meets criteria - it is just barely under a full 1 mm in two consecutive leads, and I believe that almost every ca...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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Written by Pendell Meyers, submitted by Siva Vittozzi-WongA man in his 30s with history of hypertension, hyperlipidemia, and diabetes presented with chest pain which started 12 hours prior to presentation. The pain was described as pressure, constant for 12 hours, radiating to the jaw, with left arm numbness. Initial vitals were significant for bradycardia at 45 beats per minute.Here is his presenting ECG with active pain:What do you think?Here was the prior EKG on file:The emergency medicine resident (who has received lectures from me on hyperacute T-waves, suble OMI, etc) documented the following interpretation:" In...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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