- HPI: 65F with chest pain
- Cath: Subtotal occlusion of mid-LAD. Wire passed through soft clot.
- Key ECG: The T-wave in V3 may not be hyperacute when considered in isolation; however, when considered in the context of V4, I would consider this also suspicious for being a hyperacute T-wave. V2 has a small amount of STE which is inappropriate for its QRS, as well as a possible very small Q-wave which must be assumed to be new in this scenario without a prior ECG for review. Additionally, lead V2 technically has terminal QRS distortion, because there is no S-wave (never goes back below baseline) and there is also no J-wave. Because of the possible reciprocal changes, the Q-wave, and the terminal QRS distortion in V2, the formulas (for Subtle LAD-STEMI vs BER) would be formally contraindicated. Additionally, the formula technically requires at least 1mm STE in V2-V4 to consider using the formula.
- Link to full case @ Dr. Smith’s ECG Blog