Dynamic ST Elevation

A 70-something male with 3 CAD risk factors developed intermittent left sided chest discomfort 29 hours prior.  It began again 2 hours prior to first ECG.  Pain was 7/10 radiating to left arm with SOB and diaphoresis.Here was the prehospital ECGSinus rhythm. Slight ST depression in I, aVL, and V4-V6, consistent with ischemia.These medics were smart and well trained, and so they recorded another several minutes later due to persistent symptoms:New ST Elevation in V4-V6, with obliteration of the S-waves.There is also new subtle STE in inferior leadsThey arrived in the ED and another ECG was recorded:Chest pain still 7/10Now there remains the STE in inferior leads and STD in I and aVL.  This alone would be enough to call inferior OMI even without the previous diagnostic prehospital ECG.STD in V2Hyperacute T-waves remain in V4-V6 but the STE is resolved.This is diagnostic of an infero-postero-lateral OMI (that isalso a STEMI, or STEMI (+) OMI).  It is reperfusing and re-occluding.  Thus, it can be called a " Transient STEMI "The cath lab was activated.The BP was 194/83. A nitro drip started at 50 mcg/min.  BP then 140/67 and pain improved from 7 to 3/10.The interventionalist was happy to take the patient to the cath lab, but he mysteriously commented that " there is going to be nothing there. "The initial high sensitivity troponin I returned at 83 ng/L (99th %-ile URL = 34 ng/L for men; LoD = 4 ng/L).  Depending on the population, this level&nbs...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs