Chest pain + troponin of 1600 + LBBB + 6mm ST elevation = occlusion MI, right?

This case is by Jesse McLaren (@ECGCases), with comments by Smith and GrauerA 50 year-old with CAD and ESRD went to their regular hemodialysis appointment complaining of two days of exertional chest pain. The patient was sent to the ED when high-sensitivity Troponin I returned at 1,526 ng/L (normal<26 in males,<16 in females). They were painfree on arrival, with BP 180/70 and other vitals normal. What do you think?     There ’s sinus rhythm with LBBB and appropriate discordant ST changes: there’s no concordant ST elevation, no concordant ST depression in V1-3, and no excessive discordance. Because of the chest pain and positive troponin the patient had a stat cardiology consult in the ED, which noted that the ECG revealed “known LBBB now with>5mm discordant ST elevation V2-3, positive by Sgarbossa criteria ”. The cath lab was activated, and a 70% circumflex lesion was stented. The troponin in the ED three hours after the initial troponin was 1509, and continued to fall. The patient had chest pain + ST elevation + elevated troponin + culprit lesion, so was discharged with a diagnosis of “STEMI”.But did they have an Occlusion MI? Acute coronary occlusion is diagnosed based on clinical presentation (ischemic symptoms), ECG evolution (occlusion and reperfusion), angiographic findings (TIMI 0-2 flow), and significant troponin elevation. But no factor alone is sufficient: patients can have resolved symptoms but ongoing ECG evi...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs