Acute Coronary Syndrome With ST-Segment Elevation in Inferior Leads

Abstract

A man in his 50s was brought to the emergency department with a 4-hour history of severe, crushing chest pain radiating to his left arm. His medical history was notable for diabetes mellitus and hypertension for 10 years and nonalcoholic fatty liver disease. A prehospital electrocardiogram (ECG) was recorded by the paramedics (Figure , A), and he underwent fibrinolysis with tenecteplase before being brought to the hospital. On arrival at the emergency department, he was having persistent chest pain with a blood pressure of 130/80 mm Hg, and a heart rate of 96 beats/min. Oxygen saturation was 96% on ambient air. Systemic examination findings were normal.

ST-Segment Depression in V2 With Precordial Hyperacute T-Waves Is an Anterior ST-Segment Elevation Myocardial Infarction (STEMI) Equivalent—Reply

“…In Reply We thank Drs Rubin and Montana for their comments on our Challenges in Clinical Electrocardiography . They assert that the ST-segment depression in V 2 is unlikely to be a reciprocal change to inferior wall ST-segment elevation, and more likely to represent an evolving de Winter pattern of hyperacute T waves in acute anterior myocardial infarction.…”

ST-Segment Depression in V2 With Precordial Hyperacute T-Waves Is an Anterior ST-Segment Elevation Myocardial Infarction (STEMI) Equivalent

“…To the Editor In their report of an inferior and anterior myocardial infarction (MI) owing to an occluded wraparound left anterior descending coronary artery (LAD), Kapil and colleagues attribute the ST depression seen in lead V 2 to a reciprocal change owing to inferior wall involvement by the wraparound vessel. However, whereas leads I and especially aVL will typically manifest reciprocal ST depressions in inferior wall STEMI, this is not the case with lead V 2 unless there is involvement of the posterior wall.…”