A 52 year old female with chest pain

Written by Pendell Meyers, edits by Steve SmithA 52 year old female with history of hypothyroidism and smoking presented to the ED with an episode of chest pain that began suddenly around 1500 while sitting down at work. She states it felt like a central chest pressure that radiated to her jaw. The pain had been persistently present since since 1500 (seen at 1615 in the ED), but had waxed and waned in severity, with the initial onset of pain being the worst. She had dyspnea and diaphoresis when the pain began. Coworkers called EMS who administered aspirin and NTG, which the patient says did not relieve her pain. During initial exam, she reports that her dyspnea had improved, but she had new nausea and vomiting x2 while in triage. Here is her triage ECG at1615:What do you think?Smith comment (blinded to all information): This ECG, even without an old one for comparison, is diagnostic of LAD occlusion. T-waves like this are NEVER normal and only caused by transmural ischemia.Her baseline ECG was available on file:Normal BaselineThis baseline normal ECG proves that that first ECG above shows hyperacute T waves in leads V3-6, as well as likely hyperacute T waves in II, III, and aVF when compared to baseline. These T waves are evidence of acute transmural injury in the anterolateral and likely apical LV walls, which would fit well with acute LAD OMI. There is also abnormal STE in V2-V4 which is minimal in amplitude and does not meet STEMI criteria.Please notice that an experi...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs