71 Year Old Male: Chest Discomfort- Discussion

Here is the discussion for “71 year old male: chest discomfort”
let’s review the prehospital 12 lead:

Here are the precordial leads blown up:

There is slight ST elevation in V1,  ST elevation in V2 (saddleback morphology), as well as slight ST elevation in V3 and V4. The STE in V3 and V4 is between 1 and 2 millimeters at 60 milliseconds after the J-point. This looks like what we might see in normal variant, but we have no idea what the baseline ECG would look like, and with the patient’s presentation must be suspicious. Additionally, the T wave in V3 has a “hyperacute” feel to it.
The Paramedic, known to be an excellent one, was approrpriately concerned about the above findings. A STEMI alert was called, and the patient was taken to the community hospital, which was closest but is also a PCI center.
Another wrinkle is the “saddleback” morphology of the ST elevation in lead V2. If you are a frequent reader of Dr. Smith’s ECG Blog you know that the “saddleback” morphology is rarely due to occlusion myocardial infarction (OMI). But, rarely doesn’t mean never.

Upon arrival at the hospital, the following ECG was acquired approximately 22 minutes after the last prehospital ECG:

There are significant changes from the prehospital ECG.
Here are V1-V3 side by side:

Most notably, the “saddleback” morphology is no longer present.  The ST elevation in V2 and V3 appears to be slightly less, but there is a straight...

Source: EMS 12-Lead - May 5, 2018 Category: Cardiology Authors: David Baumrind Tags: 12 lead ecg Cases ems-health-safety ems-topics patient-management Training training-development 12-Lead ECG acute anterior STEMI David Baumrind EMS 12-Lead Occlusion Myocardial Infartion (OMI) Paramedic Source Type: research