A man in his 50s with 2 hours of chest pressure

 Case submitted by Anonymous, written by Pendell MeyersA man in his 50s with history only smoking presented to the ED with chest pressure for the past 2 hours. His vitals were within normal limits except BP 163/109. No prior ECG was available. Here is his triage ECG:What do you think?This is probably obvious to regular readers of this blog, but it is NOT obvious to most emergency providers and cardiologists.Findings include: - Sinus rhythm - Normal QRS complex - Hyperacute T waves in leads II, III, and aVF - reciprocal STD and T wave inversion in aVL - STD in V2-V4 (max in V3) - Likely hyperacute T waves in V5 and V6 as wellInterpretation: diagnostic for inferoposterolateral STEMI(-) OMI. There is always a small possibility of takotsubo or myocarditis, but this ECG is OMI until proven otherwise.In our most important upcoming study, we are about to show that ECG experts are superior to simple STEMI criteria. We found that at least one of 7 key ECG findings were documented in the vast majority of cases where the expert outperformed the STEMI criteria. This case has at least three of these findings: hyperacute T waves, STE/hyperacute T waves in inferior leads with any STD/TWI in aVL, and STD max in V2-V4. The triage ECG was brought back to the ED physician immediately for review. The ED physician recognized this pattern and called a " heart alert " (this allows immediate cath consult via phone consultation and review of the ECG betwee...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs