4799861, Driver showed it to me, 5-24-19
Paired second case:
A 53 year old man with DM and HTN presented with acute onset of L shoulder/arm sensation of numbness and tightness. There was no chest pain or shortness of breath.
The ECG was texted to me, and I was unsure. I told the provider I thought the J wave in aVL was somewhat protective, however there is considerable reciprocal STD which appears out of proportion to the findings in aVL. I said that I would proceed with emergent ruleout of OMI as he had already planned, with cardiology evaluation, serial ECGs, echo, etc, however with the understanding that there is a significant chance it could be a false positive.
(When I later showed it to Dr. Smith, he instantly responded that it was a normal variant.)
Cardiology called emergently, felt it was early repol.
3 trops negative
CCTA totally normal.
Neurologic causes investigated, also negative.
Pt discharged.
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