Conclusion to Snapshot Case: 44 Year Old Male – Chest Tightness

This is the conclusion to the Snapshot Case located here. You may want to review the initial description again. As many readers correctly pointed out, this patient is experiencing a STEMI. Let's start with the basics and work our way up to some pretty advanced topics. First, there is anterior ST-elevation with upwardly-concave T-waves, as known as smiley-face T-waves. Upwardly-concave T-waves are commonly taught as being associated with benign causes of ST-elevation, but that's only part of the story. For a more in-depth analysis, check out this quick review. While it's true that they are often seen with early repolarization, their presence here does not even remotely rule-out the possibility of STEMI when there are other signs pointing in that direction. What are those other signs? Chief among them is reciprocal ST-depression. In this case reciprocal ST-depression is present in I, II, aVL, and V6 as highlighted above. While it's not unusual to see a T-wave inversion with a small amount of ST-depression in lead III with early-repolarization, ST-depression should not be present in as many leads as above were that the case. Additionally, this cannot be pericarditis because in that setting you are only allow ST-depression in leads aVR and V1. If you see ST-depression anywhere else on the EKG it is almost certainly not pericarditis. At this point, by ruling-out early repolarization and pericarditis with one simple sign, we are almost certainly dealing with ...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: ems-health-safety ems-topics patient-management Training training-development acute anterior STEMI vs. benign early repolarization case study concave up EMS 12-Lead ems12lead.com injury vector smile face ST-elevation smiley faced S Source Type: research