A 61-year old male presented
to our ER with 6 hours left sided chest pain associated with sweating. Pain occurred
at midnight at 1am. He was a known case of HTN, type 2-DM and CAG nine months
ago showed 70% stenosis in obtuse marginal branch (small vessel) and minor
plaque in mid LAD. He was on regular medications including 75mg Aspirin.
On arrival he had minimal
chest discomfort. Vitals were within normal limits. ECG taken showed Normal
Sinus Rhythm with no ST-T changes.
However, repeat ECG taken 1 hour later
during chest pain showed SR with Hyperacute T waves in anterior leads.
So, is it Anterior STEMI?
Three differentials come when
there is hyperacute T wave in precordial leads.
1. Hyperkalemia
2. Early repolarization
3. Anterior wall STEMI
LVH may also lead to tall T
waves.
In this ECG, hyperkalemia is
ruled out since T wave is not tented, QRS duration is normal. Later on his serum
K level was normal.
In early repolarization, R
wave amplitude should be tall. But in our case, the R-wave amplitude is very small (V1-V3).
He was taken to the cath-lab
and CAG revealed 95% thrombotic occlusion in the mid LAD which was
stented with a DES.
His follow-up ECG next day showed
SR with minimal ST elevation and T wave inversion in anterior leads.
(?Reperfusion T waves). There was no q waves.
He had an uneventful course
of hospitalization and discharged 3 days later.
