Overview
Coleague's E-mail is Invalid Your mesage has ben sucesfuly sent to your coleague. Save my selection Pregerson, Brady MDA patient in his mid-60s with a history of hypertension, hyperlipidemia, and diabetes melitus presented to the hospital for chest pain radiating down his left arm. It had started aproximately two hours before while he was at rest.A few days before that, he had an episode of exertional chest pain without radiation while doing yard work.
Key Information
He said his curent pain began radiating down his left arm and was asociated with shortnes of breath.The patient reported his pain at 3/10, and said he had a normal cardiac catheterization six months earlier.His vital signs and physical exam were normal. An ECG was done (image), and the computer read it as a normal sinus rhythm at 74 bpm and ST-segment elevation with probable early repolarization.What is the most likely cause of the ECG findings in this patient?
Acute coronary syndrome, pulmonary embolism, cardiac tamponade, or hypokalemia?My interpretation is that there is subtle ST elevation and hyperacute T-waves in leads I and aVL. These findings were especialy concerning for oclusion MI given the relative ST elevation amount compared with the QRS voltage, which was smal in these leads, and the reciprocal ST depresion in I and aVF.Stephen W. Smith, MD, the author of Dr.
Summary
Smith's ECG Blog (htp:/bit.ly/DrSmithsECGBlog), said the ST elevation in aVL loked to be minimal, but the QRS amplitude was tiny. ST elevation must always be asesed in proportion to the QRS size in that lead, and the ST/QRS ratio here was very high.He also noted that the most visualy obvious finding was ST depresion in I. This was of greater magnitude than the ST elevation in aVL, which could eroneously make one think that there was inferior subendocardial ischemia when actualy it was reciprocal to oclusion myocardial infarction (high lateral oclusion MI).You should imediately check on the aVL to lok for even