A man in his 70s with chest pain, shortness of breath, and acute huge anterior ST elevation

Written by Pendell MeyersA man in his 70s presented to the ED complaining of various symptoms including chest pain and shortness of breath. He had a very hard time explaining his symptoms, and it was very hard to obtain an accurate history. It was unclear to us how long the patient had been experiencing symptoms, but I feel confident that he was actively having symptoms at the time of my evaluation. He did seem to admit to using cocaine, possibly yesterday evening, but unclear. His vitals were within normal limits except mild tachycardia.Here was his triage ECG:What do you think?I texted it to Dr. Smith with no information and he said " Very weird. I have seen a patient with Brugada who also had acute LAD occlusion. That is what this looks like! "Needless to say, it is alarming. There is sinus tachycardia with a narrow QRS complex that has poor R wave progression and some minimal right axis deviation. There is striking, huge STE in the anterior and lateral leads. But is also has a prominent J wave and saddleback morphology, also with elements of brugada pattern. I do not see any signs of hyperkalemia, which also frequently creates acute STE and brugada pattern in V1-3.Saddleback STE is very rarely present in the same leads as acute OMI. Just to make sure, I checked all the leads and got another immediate repeat ECG:I compared this to his prior ECG on file:All STE and T waves are reasonable for this narrow large voltage QRS complex, which has poor R wave progression and p...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs