- HPI: 39M with 2hr substernal chest pain
- Cath: ostial left circumflex occlusion
- Key ECG: Although not striking, this is clearly a diagnostic ECG for infero”posterior” myocardial infarction due to coronary occlusion (OMI), most likely due to left circumflex (LCx) artery occlusion. There is clear ST-segment depression in V2-5, which peaks around V4. The morphology in V2 is especially concerning for a reciprocal change to “posterior” ST-segment elevation (STE). There is also subtle STE in inferior leads, with hyperacute T-waves and accompanying Q waves in lead II and aVF. Lead III has a fractioned QRS complex. These all are highly unlikely to be seen in a 39-year-old man without previous cardiac history.
- Link to full case @ Dr. Smith’s ECG Blog: 2022-12-18