- HPI: 40M with squeezing chest pain
- Cath: 90% thrombotic proximal LAD lesion that was stented
- Key ECG: This is very suggestive of LAD OMI. There is STE that does not meet STEMI criteria in V1-V6. There are normal size T-waves in V1-V3, but these T-waves are enormous relative to the QRS amplitude. These are hyperacute T-waves. Moreover, any time there is ST Elevation of any amount, it must be explained: is it normal STE? Or ischemic? One sign that eliminates the possibility of normal STE is “Terminal QRS distortion.” That is the absence of both an S-wave and a J-wave in EITHER V2 or V3. Here there is no S-wave in V3 and also no J-wave. This is very suggestive of ischemic STE and of LAD OMI.
- Link to full case @ Dr. Smith’s ECG Blog: 2019-09-22