- HPI: Middle aged man sent to ED for tachycardia
- Cath: An occlusion of the proximal LAD was then found and intervened on.
- Key ECG: The rhythm appeared to be atrial flutter, but also concerning were the ST segment elevations in I, aVL, V2, and V3, as well as ST depression in the reciprocal inferior leads. But atrial flutter can alter the baseline such that there is only apparent STE or STD. This pattern is concerning for anterior wall OMI, specifically a proximal LAD lesion. There are Q waves in V1-V3, suggesting an old anterior MI, but the T waves in V2 and V3 are fairly tall, suggesting some degree of acute ischemia. Also, there are no T wave inversions which would suggest a subacute, evolved, or reperfused MI. If there is one lead of V1-V4 with a T/QRS ratio greater than 0.36, it suggests acute MI. If less then 0.36, it suggests either subacute (over 6 hours) or old MI. In this case, the T/QRS ratio is largest in V3 at 5/9 = 0.55.
- Link to full case @ Dr. Smith’s ECG Blog: 2018-09-24