Prehospital ECG of a 50-something male with Syncope and Chest Pain

This case was sent by an excellent medic:A 50-something yo male started to chop wood when he experienced a short syncopal episode followed by 8/10 chest pain.  Ground EMS arrived, administered ASA and sublingual nitro to which he passed out again.Flight crew was called to transport for signs of shock/syncopal episodes, not ACS.Ground crew had recorded this prehospital ECG:Sinus rhythm with one PVC (first complex)And anything else?These are hyperacute T-waves diagnostic of LAD occlusion.  They begin at V3, and there is no inferior ST depression, so this is probably a mid-LAD occlusion.  The hyperacute T-waves extend to inferior leads, with a reciprocal down-up T-wave in I and aVL. So it is likely that this LAD wraps around to the inferior wall.  But all of that is not important.  What is important is that one recognizes that there is an occlusion somewhere in some kind of coronary artery.There is some ST depression in V5 and V6.It isOcclusion Myocardial Infarction (OMI).  But it is not a STEMI, as there is very little ST Elevation.  At most about 50% of OMI meet STEMI criteria. If you do not recognize this immediately, then you need lots of practice.See this lecture on electrocardiographically subtle LAD occlusion:Subtle ECG Findings of Left Anterior Descending Artery (LAD) Occlusion -- LAD Occlusion MI (OMI)The medic continues:" Everyone stated this was not a STEMI/ did not fall under STEMI guidelines, however I knew (thanks to your blo...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs