Is this Septal STEMI/OMI? Many examples of Septal STEMI/OMI

 This ECG was texted to me with the implied question " Is this a STEMI? " :What do you think?I responded that it is unlikely to be a STEMI.  Why?1. There is a saddleback.  I have only seen 2 Saddlebacks with LAD occlusion.  Links to these two are below.2. There is high voltage. It does not quite meet LVH criteria, but all I can say is that it has " the look "3. The QS-wave in V2 is associated with a biphasic P-wave.  This P-wave indicates that the leads were placed too high.  When the V1, V2 leads are placed too high, a frequent result is a QS-wave in V2.4. The QT is short.  You can eyeball it at 280 ms. The computer measured it at 284, with a QTc (Hodges correction is used by our computer) of 352 ms.  If the correction were Bazett, then it would be 393 ms, which is short for LAD occlusion (though by no means impossible).5. Septal STEMI often has ST depression in V5, V6, reciprocal to V1.Then I found out that the presentation is fever and headache in a 32 year old.I suggested serial ECGs and troponins.Serial ECGs were unchanged.  2 high sensitivity troponins were both = 4 ng/L (LoD less than 4).  This rules out acute MI, both OMI and Non-OMI.Learning Points:As above, think about:1. Saddleback2. QT interval3. Leads placed too high4. High voltage5. Looking for ST depression somewhere, especially in V5, V66. Then combine with clinical presentation and low pretest probability2 Saddleback STEMIsA Very Subtle LAD Occlusion....T...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs