41 year old male complaining of chest discomfort.
The patient has had similar episodes before (after exertion), but in the past it always cleared up after use of an asthma inhaler.
EMS finds the patient sitting in a chair.
He had just taken a shower, with no relief of the chest discomfort.
He describes the pain as "heavy" and "unrelenting".
Skin cool, pale, and diaphoretic. Breath sounds clear bilaterally.
Past medical history: Asthma
Medications: Inhaler (unknown type)
SpO2: 91 on RA
The cardiac monitor is attached.
A 12 lead ECG is captured.
What's going on here?
*** UPDATE ***
This following ECG was captured en route to the hospital.
Look very carefully at lead V3!
Does this help with the diagnosis?
This case was especially difficult because our normal "tricks" to differentiate between acute anterior STEMI and benign early repolarization lead us in the wrong direction!
In other words, R-wave progression is intact and the QTc is not prolonged.
In this case it's the serial ECGs that save the day.
Remember, there is no "always" in medicine!