A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

Case written and submitted by Brandon Fetterolf MD, edits by MeyersA woman in her early 30s with multiple autoimmune disorders including vasculitis presented with 2-3 hours of mid-left side chest discomfort with radiation to neck and left arm and associated with nausea, diaphoresis and dizziness. Initial ECG on presentation at 1554 (no prior for comparison):What do you think is happening to his 30s woman? The ECG shows NSR with a normal QRS except for poor R wave progression and pathologic QS-waves in V2-3. There is STE and hyperacute T waves in V2, I, and aVL with reciprocal STD in II, III, and aVF. This is the South African flag pattern. There is also the impression of slight STE in V1 and slight STD in V6, which is seen in LAD OMI. The ECG is diagnostic for acute transmural infarction of the anterior and lateral walls, with LAD OMI being the most likely cause (which has various potential etiologies for the actual cause of the acute coronary artery occlusion, the most common of which is of course type 1 ACS, plaque rupture with thrombotic occlusion). There is clearly sufficient STE for STEMI criteria in leads V2 and aVL, but lead I has less than 1.0 mm of STE - thus, technically this ECG does not meet STEMI criteria, although it is a quite obvious OMI.This ECG was immediately discussed with the on-call cardiologist who said the ECG was " concerning but not a STEMI. " They refused emergent transfer and advised further ED workup.Initial hs-troponin I: elev...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs