Another STEMI in a Young Person with no CP or SOB: Why We Should Record an ECG for Unexplained Nonspecific Symptoms

There are many interesting facets to this case.  I have highlighted the clinical factors over the ECGs, but the ECGs are very instructive as well: even after successful PCI with good (TIMI-3) in the epicardial coronary artery, there are ECG signs of poor microvascular perfusion.  CaseA 31 year old male.  No known past medical history.  No cardiac risk factors.Here is a great medical student history:The patient presents to the ED with a complaint (through an interpreter) of a sore and itchy throat which led to feelings of generalized body pains that the patient describes as "cold pains" and feeling "tense/revved-up" or anxious and like he needed to "leave the room to scream, yell, and run around".  The throat pain is described as sore, tight, itchy and it resolved with the ending of each "episode", each of which lasted ~5-10 minutes and completely resolved. Similar episodes continued to recur throughout the day and would last ~5-10 minutes and resolve with periods of feeling normal in between each one.He endorses similar episodes one time 3 months ago and 1 week ago.He exercises regularly without exertional CP or dyspnea. He denies Chest Pain or tightness, palpitations, SOB, vision changes, diaphoresis, dizziness, or voice changes. He had an episode while in ED that included his usual symptoms + HA, mild epigastric discomfort (consistent with his previous "gastritis pain") and nausea.  The faculty physician asked several times about chest pai...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs