Outside ECG
ECG at ED
A 50 year old known hypertensive presented with central chest pain since 4 am referred from a local hospital with a report of negative Trop I. On arrival @8:00am HR 40, BP 140/70 on arrival. ECG Shows subtle J point elevation over II,III, aVF, ST Depression over aVL. A clinical diagnosis of OMI was done though ECG doesn't satisfy diagnostic criteria of STEMI. PCI pathway was activated immediately. Patient went to cardiac arrest during Cath, had VT defibrillated and stabilized. PCI revealed RCA Occlusion. Isolated T wave inversion with a subtle J point elevation should rise a strong suspicion of IWMI. One should not wait for a full ST Elevation in ECG to develop. These patients should be taken up for PCI at the earliest.
Any primary STD in aVL (i.e not secondary to LBBB, LVH or WPW) makes any inferior STE an inferior MI until proven otherwise, and excludes pericarditis.
