A man in his 50s with acute chest pain, now resolved, has 2 undetectable troponins. CT Coronary Angiogram?

 Written by Pendell MeyersA man in his 50s presented to the ED with chest pain described as pressure, without radiation, acute onset about three hours prior to arrival. He had had stuttering less severe versions of this pain all week that usually went away after a few minutes. He also had diaphoresis and dyspnea. He had extensive family history of CAD with CABG ' s in the mid 50s for multiple relatives, but he had no personal known history of CAD. It is unclear whether he had pain at the time of triage, but notes describe that his pain had subsided by the time of EM physician evaluation:Triage at approximately 2130:What do you think? Decide before viewing the baseline ECG available below, then decide again in the context of the baseline ECG.Baseline ECG on file from 5 years ago:The baseline ECG is basically normal, with some high voltage possibly indicative of possible LVH (but no obvious LVH repol abnormalities), and borderline left axis deviation (also possibly due to LVH). These T waves and ST segments are normal for this QRS complex.The triage ECG above shows reperfusion of OMI in the midanterolateral pattern which is now called " South African flag sign " (V2-3 areas, then " skips " the lateral precordial leads and reappears in I and aVL)-- T-wave inversion in aVL, with flattening in lead I--Reciprocallyupright and hyperacute inferior T-waves (These appear to be inferior hyperacute T-waves, but are actually reciprocal to the inverted T-wave in aVL!!)  ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs