- HPI: 45M with CAD p/w 3 hr typical chest pain
- 3V formula score: 23.9 (>23.4 favors OMI)
- Key ECG: There is ST elevation and tall T-waves in precordial leads, with reasonably good R-wave progression. He is a 45 year old male, so this could be male pattern benign early repolarization (BER, or ER). But it could be anterior STEMI. 40% of anterior STEMI has upward concavity in all of leads V2-V6. How can one decide whether this is ER or MI? First, if an old ECG is available, then compare. Only rarely does early repolarization change from date to date, though it is possible.
- Link to full case @ Dr. Smith’s ECG Blog: 2011-06-18