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  • David Didlake
    • Aug 30, 2022
    • 1 min read

Missed Opportunity

Updated: Aug 30, 2022

New onset chest discomfort with demonstrable Hyperacute T waves that went undetected by EMS, EM, and cardiology.


Case review presentation:


Learning Objectives

  • Hyperacute T waves are disproportionately large in comparison to their paired QRS, and represent Grade I Sclarovsky-Birnbaum ischemia.

  • Diffuse / global ST depression is consistent with subendocardial ischemia (supply-demand mismatch) when maximal in Leads II and V5. Consider a focal reciprocal change when maximal depression is elsewhere.


Below is the link for detailed review on the hyperacute T wave (with expert commentary by Dr. Steve Smith).



About Me

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I am the Battalion Chief of EMS for Hilton Head Island Fire Rescue and obsessed with all things process improvement, system performance, human factors, crew resource management, and evidence-based performance measures for time-sensitive diagnoses.

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