A man in his 60s with chest pain. Could you have prevented his cardiac arrest?

Written by Pendell MeyersA man in his 60s with HTN and AF presented with chest pain that started about 1 hour ago and started to subside during transport via ambulance. Vitals were normal except for a heart rate of 49 bpm at triage.Here was his EMS ECG recorded just before arrival:What do you think?Sinus bradycardia with clear but subtle evidence of inferior OMI. The T-waves in III and AVF are certainly hyperacute, as they are fat and wide compared to their small, normal QRS complexes and are corroborated by the inappropriate T-wave inversion in aVL. Lead II would probably also be proven to be hyperacute in comparison to a baseline ECG if we had one with a clear baseline T-wave.V3 also has a hyperacute appearance, but I am not sure how to reconcile this with the distribution of findings in the rest of the ECG.The only available prior ECG in the system was this one in atrial flutter:Despite flutter somewhat obscuring the T-waves, you can see that the inferior T-waves at baseline are not as big as the presentation ECG, proving they are indeed hyperacute. The T-wave in aVL is upright at baseline, and inverted in the presentation ECG.The ED physician was worried about the EMS ECG and obtained an immediate repeat on arrival in the room:Sinus bradycardia persists, but the hyperacute T-waves are deflating compared to the EMS ECG. It would seem that the patient is reperfusing at this time, which of course fits with the clinical data of decreasing pain. Of note, V3 is also improving, ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs