A man in his 60s woken from sleep by epigastric pain. Would you have been able to correctly diagnose him?

Written by Pendell MeyersA man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. He called EMS who brought him to the ED. He had active chest pain at the time of triage at 0137 at night, with this triage ECG:I sent this ECG, without any text at all, to Dr. Smith, and he replied: " LAD OMI with low certainty. V3 is the one that is convincing. " After his response I sent him the baseline ECG (below), still with no context at all except that this was his prior ECG:Dr. Smith replied: " Now high certainty. By the way, the formula using QTc of 410 and STE60V3 of 3.5 was 19.4. I bet this LAD occlusion was missed. "  (Also, R-wave amplitude in V4 of 12, and QRS in V2 of 16)I replied: " You ' re right about both. It was LAD occlusion, and of course it was not seen until about 6 hours later. " Here is the ECG again: The computer QT / QTc is 428 and 461 msec.Using the computer ' s QTc of 461 ms instead of Smith ' s, which was measured by him (at 410 ms) while looking on an iPhone screen, you can see the formula value below.  There is sinus rhythm with overall normal QRS complexes, normal R wave progression. There is STE in V2-V4, maximal in V3. The T wave in V3 and V4 is likely hyperacute, as it is fat, broad, full, and nearly symmetric in V4. A prior ECG, if available as in this case, would help to confirm or deny whether these are truly hyperacu...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs