- HPI: 50s M p/w exertional chest pain & dyspnea
- Cath: complete acute occlusion (TIMI 0) of the RPL (right posterolateral artery), requiring 3 stents to restore TIMI 3 flow.
- Key ECG: subtle inferior (and likely also posterior) OMI. There is a small and narrow QRS complex with reasonable axis and R wave progression, therefore the QRS cannot explain any abnormalities of the ST segment and/or T waves. The T waves in II, III, and aVF are subtly too large for their QRS, and the most important finding is that, in aVL, there is reciprocal STD and proportionally-large-volume T wave inversion (a “reciprocal negative hyperacute T wave”). There is also slight STD in I.
- Link to full case @ Dr. Smith’s ECG Blog: 2021-06-06