A 49 year old man with chest pain. Is it OMI? is it pseudonormalization?

Written by Pendell Meyers Before we get to the whole case, let ' s interpret this ECG without any other context except to say that this is a 49 year old man with acute onset chest pain:What do you think? This will be called " ECG2 " .Here is the whole case:A 49 year old man with no medical history presented with acute onset chest discomfort for several hours which improved to 2/10 severity at the time of arrival to the emergency department. Here is his triage ECG (ECG1) at 1750:What do you think? Form your opinion, then see the baseline ECG below and see if your opinion changes.A baseline ECG was available:This baseline ECG is normal.The presentation ECG shows several abnormalities: - new STE in V1-V3 (does not meet STEMI criteria) - T waves in V1-V3 have increased in area compared to prior (concerning for hyperacute T waves) - new very slight STD in V6 - Q waves in V1-V3 (V3 is new) - Terminal T wave inversion in V4 and V5 indicating reperfusion. Also very subtle terminal T-wave inversion in lead V3!These findings together are concerning for LAD OMI which has just started to reperfuse (there are terminal T wave inversions of reperfusion, but some persistent STE and large T waves, likely " on the way down " ). This fits especially well with the clinical data: the patient had severe pain and is now improved.Knowing what we know about the reperfusion progression, if the patient remains reperfused then we would expect serial ECGs to show contin...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs