- HPI: 40M with chest pain
- Cath: 100% acute thrombotic LAD occlusion
- Key ECG: QRS distortion, which does not happen in early repol or in pericarditis. This is when there is an absence of BOTH and S-wave AND a J-wave in EITHER V2 or V3. This ECG only barely has an S-wave in V3 (the S-wave only goes 0.5 mm below the PQ jct.) There is ST elevation in V1-V3, maximal in V2 at barely more than 1 mm (measured at J-point, relative to PQ junction). The T-wave in V2 is nearly peaked. It does not have the typical wide and fat appearance of an ischemic hyperacute T-wave. Look at inferior leads: there is downsloping ST depression with a down-up T-wave in III and aVF. These are highly suspicious for reciprocal changes of LAD occlusion
- Link to full case @ Dr. Smith’s ECG Blog: 2016-06-24