The resident made the diagnosis immediately. The faculty was not as certain.

This was sent by one of our G2 residents, working at a different hospital." A 50-something male with a history of hyperlipidemia but no known cardiac history woke up with sudden onset substernal pressure and nausea/vomiting and diaphoresis. "EMS recorded this ECG: What do you think?" The medics were concerned by the story and they saw some ST Depression in the inferior leads and so they gave ASA and nitro with some relief. On arrival to ED we got a 12-lead ECG and looked at the prehospital EKG. " Here is that first ED ECG:Resident: " My interpretation was STD in II, III, and aVF with hyperacute T waves in aVL and I.  I was concerned for high lateral OMI.  There is also a hyperacute T-wave in V2. "Smith: the prehospital ECG and first ED ECG are both diagnostic of a high lateral OMI.  " Inferior ST depression " is actually reciprocal to high lateral ST elevation until proven otherwise.  The inferior STdepression (rather than the STElevation) is often the most visually stunning feature.  The T-wave in lead III is areciprocally inverted hyperacute T-wave.  The hyperacute T-wave in V2 makes this a mid-anterolateral OMI which is due to D1 occlusion.  There is also a bit of ischemic ST depression in V5 and V6.Here are some old posts on inferior ST depression: http://hqmeded-ecg.blogspot.com/2010/08/st-depression-does-not-localize-2-cases.html Resident Continues: " My attending definitely thought it was a concerning EKG...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs