A man in his 40s with chest pain reproducible with palpation

Written by Pendell Meyers, submitted by George KonstantinouA man in his early 40s with history of smoking and hypertension presented to the ED with substernal and right sided chest pain of 8 hours duration. The pain had first started after a stressful event and had waxed and waned several times over the 8 hours. The pain was reproducible with palpation on the right side of the chest.Here is his initial ECG:Notice the leads configuration (this ECG comes to us from Greece).There is sinus rhythm with very small STE in V2-V3. The T waves in V2-V5 are very concerning for hyperacute T waves with increased area under the curve. Comparison with a prior ECG (unavailable in this case) would almost certainly show dramatically increased area under the T wave. There is the smallest hint of STD in V5-V6 and III. There is very poor R wave progression, with minimal R waves throughout the precordium.Here, Ken Grauer has calculated the 4-variable formularesultsfor the presentation ECG:For the four-variable formula, 18.2 was the derived cutpoint with the highest accuracy at 92%, sensitivity 88.8%, specificity 94.7%. A value> 18.2 supports LAD occlusion, while a value< 18.2 supports normal ST elevation. The closer the score is to 18.2 (e.g.>17.7 or<18.7) the more likely it is to represent a false negative or false positive. 19.62 is very concerning for true LAD occlusion.Simplified alternative formulaThere is also a simplified formula developed by Dr. Emre Aslanger, based on the orig...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs