- HPI: Middle aged man with chest pain for hours
- Cath: nearly occluded D1
- Key ECG: The STE in aVL, with minimal reciprocal ST depression in inferior leads, in the setting of well-formed Q-waves, is of unknown age, but very likely to represent old lateral MI with persistent ST elevation. There is less than 1 mm of STE in I, aVL, V5 and V6, but these leads are notoriously insensitive for coronary occlusion. Only about 50% of occlusion of arteries supplying this area of myocardium have ST elevation that meets “criteria” of 1mm or more. The T-waves in V5 and V6 make this suggestive of coronary occlusion. They are far too tall and fat to be normal. They are hyperacute.
- Link to full case @ Dr. Smith’s ECG Blog: 2015-07-10