A man in his 50s with fever and shortness of breath

Written by Pendell MeyersA man in his 50s with HTN, HLD, obesity, and restrictive lung disease presented with shortness of breath worsening over the past 3 days. He also had a cough and subjective fevers. He denied chest pain. His vitals were within normal limits.Here is his triage ECG (no baseline available):What do you think?Findings: - sinus rhythm at about 100 bpm - STE in I and aVL (meets STEMI criteria) - hint of STD in III and aVF - STD in V1 and V2 - hyperacute T-waves in I and aVL (with reciprocal negative hyperacute T in III)Interpretation:This is definitive evidence of acute transmural injuryand active infarction of the lateral and posterior walls. In any adult population with symptoms potentially compatible with ACS, the most common etiology of this focal transmural ischemia is Occlusion MI (type 1 ACS). But there are other etiologies such as coronary spasm, takotsubo/stress cardiomyopathy (which rarely has reciprocal findings because it is usually widespread), focal myocarditis (rare, but usually does have reciprocal findings), etc. The cells of the posterior and lateral walls do not know the etiology of the transmural injury, and the ECG findings are the same regardless of the etiology.Back to the Case:With his infectious and respiratory symptoms and complete lack of chest pain, we did not activate the cath lab despite the ECG meeting STEMI criteria. Instead, we called cardiology to assist us in the ED to make sure that they agree he doe...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs