- HPI: 40-something with abdominal upset x 1 week
- Cath: Severe 3 vessel Coronary artery disease involving the LAD; 100% mid LCX occlusion; first troponin 3000 ng/L
- Key ECG: This is Aslanger’s pattern. You’d better get an angiogram or at least a stat echo. There is single lead STE in III, with recipocal STD in aVL (inferior OMI). There is STD in V3-V6 diagnostic of subendocardial ischemia. Aslanger pattern, even if the STE is less than 1 mm (with reciprocal STD in aVL), is diagnostic of OMI in the right clinical situation. This presentation has a low pretest probability, so obtaining an echo is wise, UNLESS the troponin comes back diagnostic, as in this case
- Link to full case @ Dr. Smith’s ECG Blog: 2021-08-10