A 58 year old collapses in the hot sun

A 58 yo male was out working in the hot sun for 2-3 hours. He stated he almost passed out, and bystanders called 911. They give him water with salt, as he thought he was dehydrated.When medics arrived, he was alert, sweating, and felt weak.  He walked to the ambulance for evaluation.  He denied headache, chest pain, nausea / vomiting and dyspnea. He had no cardiac history, meds, or risk factors. Vitals were obtained, and placed on cardiac monitor, including this 12 lead prehospital ECG: QTc =  320 ms; (QTc = 374 ms)The computer measures the ST Elevation at the J-point for you.Here it is 4.08 mm in V2, and 2.84 in V3, as well as 2.34 mm in V4.This looks worrisome for anterior MI, and with ST elevation in aVL and reciprocal ST depression in inferior leads, it looks like aproximal LAD occlusion.Or is it normal variant ST Elevation (often known as early repolarization?)This has been thoroughly studied by me and Dr. Emre Aslanger (an interventionalist) in a series of articles:Here is the3-variable formula for differentiating normal variant STE from LAD occlusion.The 3-variable formula has been superceded by the 4-variable formulaCalculate the 4-variable formula at MDcalc, or get the iPhone app ( "SubtleSTEMI" ), or the Android app ( "ECG Smith" )This 4-variable formula wasexternally validated by Emre Aslanger.Then, Dr. Aslanger produced asimpler formula that does not require QT correction.In these studies differentiating Subtle LAD occlusion from...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs