Atrial Fibrillation w Rapid Ventricular Response and ST Depression Maximal V1-V4: Not always subendocardial.

A patient presented a few years ago with chest pain, but also cough, low grade fever, and malaise.  She had one prehospital saturation at 88%, but otherwise all vital signs and labs were normal, without tachycardia, elevated BP or anemia.  She was never in any distress.She had this prehospital ECG:What do you think?There is diffuse ST depression, in I, II, III, aVF and V3-V6.  It is diagnostic of ischemia.  It is maximal in V5 and II, with reciprocal STE in aVR, and is thus most consistent with subnendocardial ischemia (Posterior OMI would have maximal STD in V1-V4, and Posterolateral OMI would have STD in lead III but without STD in lead I).  So this is not typical of OMI.  Most likely, this patient does not have OMI.By the time of arrival in the ED, the ECG had normalized. It is not clear that any physician ever saw that prehospital ECG.She was admitted, not given aspirin in the ED, andhere are the serial troponins:  the first 6 are from a previous visit, showing that she does not have chronic myocardial injury (chronically elevated troponins).  The last 5 are from a subsequent visit showing she does not have chronic injury afterwards either. This is a rise and fall of troponin diagnostic of acute myocardial injury.  When there is proven ischemia, as there is by the ECG, then acute injury isacute MI. Then you must decide if it is type I or type II.  She was diagnosed with " Type II MI " (due to supply demand m...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs