|There is sinus tachycardia. There is ST elevation in V1-V4, but there is also very high S-wave voltage in these leads. There is a high voltage R-wave in V5. There are no reciprocal changes.|
Further history: There was also a productive cough. CXR showed right sided infiltrate. In spite of all this, the cath lab was activated. Coronaries were clean.
Tachycardia was due to dehydration. Chest pain due to pneumonia. ST elevation due to LVH.
LVH is one of the most common pseudoinfarction patterns. High S-wave voltage is followed by discordant ST segments; that is, by ST elevation in precordial leads, sometimes striking.
However, LAD occlusion in these cases is very uncommon. In fact, I have only seen 2 cases of LAD occlusion in the presence of clear V1-V6 LVH. I believe, but cannot prove, that this is not because these individuals do not get LAD occlusion, but because when they do, it attenuates the voltage and erases the LVH. I am in the process of studying this.
For other cases of LVH mimicking STEMI, go here: http://hqmeded-ecg.blogspot.com/search/label/LVH