A 49 year old woman with chest pain arrived. The medics had recorded this ECG. What is the diagnosis?
Let's go back in time 13 days:
A 49 yo woman with a h/o LAD stent, on aspirin and clopidogrel, complained of brief episodes of substernal pressure-like chest pain relieved by nitroglycerine. She was seen in the ED on day 0 and was pain free in the ED. She had had a previous anterior MI and had some baseline minimal wall motion abnormality.
Here is her ECG from 2 years prior:
Here is her ECG on the first day of presentation (day 0):
The cardiologist decided to do an sestamibi stress test. The first part of the test was done as an inpatient, but the patient was sent home with instructions to follow up for the second part of the scan.
Apparently she did not show up.
On day 13, this woman presented with chest pain.
And this brings us back to the ECG at the top. It was recorded at t=0 on day 13 by EMS, 15 minutes prior to ED arrival.
The cardiology fellow looked at the ECG and did not recognize MI, and wanted to deactivate the cath lab, but reconsidered after the following initial ED ECG was recorded.