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ECG of the week #9: 60 year old with chest pain

Test yourself with this week’s ECG case. Then scroll down for a structured step-by-step interpretation and clinical pearl.

Clinical Scenario

A previously health 60 year old presented with acute chest pain

ECG

Question

Any signs of occlusion, and if so where is the culprit?

ECG Analysis

H: normal sinus
E: normal conduction
A: normal axis
R: normal R-wave progression
T: normal voltages
S: STE V4-5, hyperacute T waves V2-5 and inferior with reciprocal disproportionate TWI in aVL

Answer

Wraparound or distal LAD occlusion

Clinical Pearl

Distal or wraparound LAD occlusion can cause STE/hyperacute T waves across the precordium and into the inferior leads

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