u/Amernkou

Called to 60s male complaining of rapid onset chest pain while at rest approximately 30 minutes prior. Described as substernal pressure with radiation. Hx of MI and coronary stent. Prior to lead placement, vitals noted to be normotensive with tachycardia at 170 bpm. EKG 1 was obtained on scene and interpreted as SVT with LBBB. Converted to sinus tachycardia without aberrancy after 6mg adenosine following failed Modified Valsava. Post-conversion EKG obtained but not attached due to artifact; however, was noted for concerning anterior T waves. 3rd EKG immediately prior ED arrival is attached as EKG 2. Interpreted as sinus tachycardia with De Winter T waves in v2-v3.

I see an ongoing OMI but thought I would bring it to the group for discussion. Outcome in comments.

54yo male with 9/10 substernal pressure, non-radiating pain and L arm numbness. Reports sudden onset of pain while working outside with accompanying dizziness and collapse. X2 previous MI with similar pain and x2 stents placed. ASA and x1 NTG admin with no pain relief. Further NTG withheld due to 90s/60s BP post-admin. EKGs attached in order with 15 min increment between 12 leads. 15 lead obtained within 2 min of initial 12. Initial EKG interpreted as sinus rhythm with RBBB, R axis deviation and expected T wave changes for RBBB. Repeat EKGs noted for continued development of RBBB which was concerning for an ischemic change. No baseline EKG available and patient unaware if RBBB is normal. Transported to PCI facility.