- HPI: 40M with chest pain x 1hr
- Cath: 100% RCA occlusion
- Key ECG: STE in inferior leads and STD in I and aVL which do not meet STEMI criteria, but suggest OMI. The principal ST-T wave abnormality in this tracing is ST segment straightening and slight ST depression in leads I and aVL. Although isolated T wave inversion in lead aVL would not necessarily be abnormal (especially given the predominantly negative QRS complex in this lead) — there should not be ST flattening with ST depression in both of these high lateral leads. Given the history of new-onset chest pain — this ECG finding is ischemic until proven otherwise.
- Link to full case @ Dr. Smith’s ECG Blog: 2019-04-22