Mid LAD Occlusion

A 50 y/o Male presented to the ED with new-onset chest discomfort. He reported no pertinent history (eg, HTN, HLD, DM, Smoking, etc).

The initial Trop I returned <0.012 ng/mL.

Here is the time-zero ECG.

The critical features that immediately caught my attention were both the hyperacute T-wave in aVL, and the reciprocal down-up T-wave in III.

Here's a formal review of Hyperacute T waves:

https://www.ems12lead.com/post/the-hyperacute-t-wave

While waiting for the Cath Lab a STAT Echo demonstrated preserved EF, however Anterior/Apical wall motion abnormality.

The Queen of Hearts further corroborates the suspicion of acute OMI.

He was transported to the Cath Lab where an acute mLAD culprit lesion was stented.

Here is the post-procedure ECG with very apparent reperfusion T-waves. Peak Trop I 0.879 ng/mL. He was discharged on Brilinta, Aspirin, Statin, and Lisinopril.