- HPI: 20-something man with chest pain x 2.5 hr “Tight and pressure, radiates to right arm, + nausea, + SOB”
- Cath: 99% stenosis in the RCA, and proximal to a posterolateral branch. A coronary aneurysm was found.
- Key ECG: Reciprocal STD in aVL (this occurred in 0 of 66 cases of early repolarization and 99% of patients with inferior STEMI). T-waves in inferior leads are hyperacute, out of proportion to those in early repol. T-wave inversion in V2 is inconsistent with early repol, and is typical of posterior ischemia. Also, when there is normal variant STE in inferior leads, there is usually also normal variant ST elevation in V5 and V6 (which is not present in this case)
- Link to full case @ Dr. Smith’s ECG Blog: 2013-08-31