Next day – more chest pain, this time with onset at rest, lasting 3 hours, still present on ED arrival, relieved by GTN. The above was his ECG.
There is very subtle but significant ST elevation in his inferior leads, with subtle slight ST depression and no T’s in aVL. This is STEMI! The resident didn’t recognise the significance, sent TnT, gave an aspirin and referred for a “rule out ACS” admission under the medical team (bizarre Tassie referral set-up, don’t ask!) but at least didn’t send him home. TnT came back at 2.5 – I activated the cath lab….
A great discussion by Steve Smith (whose ECG blog is an amazing resource) of a subtle inferior STEMI is here: http://hqmeded-ecg.blogspot.com/2011/12/subtle-inferoposterolateral-stemi.html