- HPI: 35M with acute chest pain
- Cath: Occlusion of the very distal LAD s/p thrombectomy 3V fomula score: 23.9 (>23.4 favors OMI)
- Key ECG: This is highly suspicious for LAD occlusion, though not diagnostic. The 3V formula score is 23.9 (which is > 23.4 which is pretty specific for LAD occlusion). Consider frequent serial EKGs, every 15 minutes, for several hours, an emergent formal contrast echocardiogram and if still non diagnostic, consider immediate angiography. One might argue, with good rationale, that such a small MI can wait until the next day for angiogram.
- Link to full case @ Dr. Smith’s ECG Blog: 2015-11-18