70 year old woman with non-exertional non-radiating chest discomfort

This was sent by a reader:" I would really appreciate your thoughts on this ekg progression. 71 yo F, only risk factor hyperlipidemia, has isolated chest discomfort, non-exertional and non-radiating. "Sinus rhythm with one PVC.What do you think?Smith response:This ECG has symmetric (hyperacute) T-waves in V2-V4.  It is diagnostic of LAD occlusion.If you ' re uncertain, use theformula: https://hqmeded-ecg.blogspot.com/2017/11/12-cases-of-use-of-3-and-4-variable.htmlI applied it here after measuring a QTc of 440 ms.The value comes to 19.73 (greater than 18.2 is quite good for Diagnosis of LAD occlusion.)Even if you measure QT as 411 ms, it still comes to greater than 18.2.The reader continues:" I saw slight elevation avL and slight depressions inferiorly prompting repeat ekg 1 hour later. "Now it is an anterior STEMI, obvious to anyoneLearning Point:Use the formula for differentiating subtle LAD occlusion from normal ST Elevation.===================================MY Comment by KEN GRAUER, MD (2/22/2020):===================================This case is short. The patient is a 71yo woman who presents with chest discomfort. The concise Smith response summarizes the essentials: “This ECG has symmetric (hyperacute) T waves in V2-thru-V4. It is diagnostic of LAD occlusion. "I ’ll add 3 thoughts on the initial ECG that I’ve redrawn in Figure-1.Figure-1: I ’ve numbered the beats in the initial ECG (See text).THOUGHT #1:&nbs...

Source: Dr. Smith's ECG Blog - February 25, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs