The patient was put on heparin and eptifibatide and transferred to our institution. Here, he remained pain free. His initial Troponin I was 16 ng/ml. A 3rd ECG was recorded at 2202:
|The ST depression in precordial leads is gone. The biphasic T-wave in aVL remains, with an abnormal reciprocal ST segment in lead III.|
The next AM the patient went into atrial fib with RVR:
|The tachycardia has resulted in recurrent ischemia. Now there is ST elevation in aVL (and reciprocal ST depression in lead III) and ST depression in precordial leads (posterior subepicardial ischemia).|
He was taken for cath and had a 100% occlusion of a large 1st obtuse marginal (circumflex). Ultrasound confirmed a posterolateral wall motion abnormality. The troponin peaked at 74, went down, then went back up to 180 after the atrial fib, and down again.