A 50-ish year old man presents with central crushing chest pain on a background of intermittent chest pains for a couple of days, tenuously related to exertion, maybe a bit postural, perhaps a recent coryzal illness, definitely a bit vague. This was his ECG with pain on arrival to ED:
He got aspirin 300mg, a couple of sublingual GTN sprays and 5 mg of morphine rendering him pain free. Past history significant for a throat SCC treated by excision and DXRT some years previously. Continues to smoke heavily. His first troponin was <0.01.
So, is this BER, pericarditis or STEMI?
Applying the Steve Smith formula for just this purpose to this ECG we get ~24.345, which is >23.4 and therefore suggests STEMI. So, is it??? Well, I left the hospital after snapping this ECG and seeing that first troponin was negative, so I don’t know the answer yet…but I will follow him up and keep y’all posted! Please comment on this post – I am keen to see what others think! Watch this space…