A man in his 50s with " gas pain "

Written by Pendell Meyers, sent by AnonymousA man in his 50s with history of type 2 diabetes, HTN, and HLD presented with one day of off and on chest / upper abdominal pain. It had awoken him from sleep earlier, and he described it as " gas pain, " located in the upper epigastrium and radiating upwards. Vitals were within normal limits. The patient presented with active pain, diaphoretic and ill appearing.Here was his triage ECG (sorry for the quality, unable to obtain better images from sender):Last ECG on file is below for comparison. First try this ECG without the baseline, then with. What do you think?Previous ECG on file (never just assume its the baseline, but I think this one looks consistent with a baseline).The presentation ECG shows sinus rhythm at almost 100 bpm. There is STD in V3-V6 (maximal in V4-5) and lead II, aVF, I, and aVL. Because of widespread STD, there is obligatory STE inaVR(theaVerageReciprocal lead of the rest of the ECG).This pattern in isolation would signify diffuse supply/demand mismatch without focal complete occlusion, which would be a very large differential of anything causing severe global supply demand mismatch, including ACS and various other processes. However, there is STE in V1 with a large area T-wave which is hyperacute.This fits the pattern we have described many times including recently, of subtle STE and hyperacute T-wave in V1 with STD in the lateral precordial leads, indicative of LAD occlusion (more specifically, subtotal occlus...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs