- HPI: 50M with 1hr chest pain
- Cath: 100% occlusion on of the circumflex, proximal to the first obtuse marginal, was found, opened, and stented
- Key ECG: There is ST Elevation (STE) in II, III, aVF, with reciprocal ST depression in aVL. There is also ST depression in V2 and V3. V2 and V3 almost always have some amount of normal ST elevation, and since posterior MI is associated with inferior MI, you must make notice of this and think it is probably an inferior posterior MI. However, II, III, and aVF have what appear to be J-waves at the end of the QRS. If these are J-waves, then couldn’t the inferior ST elevation be due to early repol? 1) When there is ST depression in aVL, early repol as a cause of inferior STE is VERY unlikely. 2) These do NOT appear to be J-waves.
- Link to full case @ Dr. Smith’s ECG Blog: 2018-05-06