A 53 yo woman with cardiogenic shock. Believe me, this is not what you think.

This was sent by a reader.A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock.pH was 6.9 and K was normal.Here was the ECG:There is sinus tachycardia.This is " Shark Fin " morphology.Shark Fin has also been called:"Giant R-wave""Triangular QRS-ST-T waveform"Usually shark fin is in one coronary distribution and represents massive ST elevation that is as high as the peak of the R-wave and thereforefuses the R-wave and ST segment.So Shark Fin really is just a dramatic representation of STEMI, and can be in any coronary distribution.It is often confused with a wide QRS due to conditions such as hyperkalemia. But it is very distinct from hyperkalemia (and anything else, including VT), and such confusion can only be due to lack of familiarity, because, if you look closely, its morpholgoy is very different from anything else.So this is STEMI, right? Which artery?There is ST Elevation in every lead except aVR (STD in aVR).Well, don ' t we see diffuse ST Elevation in Myo-pericarditis (with STD in aVR)?  Could this be myopericarditis?The patient was hypothermic at 90 degrees F (32.2 C) and she was positive forinfluenza.  Her troponin I was500.01 ng/mL (equivalent to a high sensitivity troponin I of 500,000 ng/L).  This is among the highest troponin I of which I have ever heard.Her ejection fraction was 10%.She was taken to the cath lab and her coronaries were clean!!There was no MRI, but the presumptive diagnosis is myocardi...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs