Chest pain and Inferior T-wave Inversion. Does this patient need emergent cath lab activation?
This ECG was texted to me, initially with no information:What do you think?There are QS-waves in III and aVF. There is a qR in lead II. There is minimal STE, upsloping, with T-wave inversion in lead II. Leads III and aVF only have deep, fairly symmetric T-wave inversion.My interpretation and reply (paraphrase):There is subacute inferior MI and there has probably been prolonged pain. The initial troponin will be high. With T-wave inversion, it is possible that the artery has opened, but with subacute MI, the T-wave may be invertedeven with persistent occlusion. If there is persistent pain, then it is persistent OMI and the patient should go to the cath lab.Notice also: the T-wave in aVL is large and upright. Is this a hyperacute T-wave? No! It is reciprocal to the negative T-waves in inferior leads. See explanation at bottom of case.Here is the history:A 50-something woman chest pain for the last week that acutely got worse in the last day and was associated with nausea, diaphoresis, vomiting. This pain is been ongoing for many hours.The first troponin I was very elevated at 9.13 ng/mL.The interventionalist was not entirely on board with this and said " It is not a STEMI. " My very astute partner said, " No. It is an OMI. "Angiogramshowed a 100% subacutely occluded RCA. It was opened and stented.Echo:The estimated left ventricular ejection fraction is 59 %.Regional wall motion abnormality-inferi...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Steve Smith Source Type: blogs