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A Man in his 20's with Syncope. What is diagnosis? And what does the old ECG show?

Posted Oct 15 2012 12:58pm
A young man presented after a syncopal episode.  He felt fine in the ED.  He had no previous cardiac history, but stated that he does have an abnormal baseline ECG

Here is his ED ECG
There is a hyperacute T-wave in lead III which is far larger than a small QRS.  There is reciprocal ST depression and and inverted reciprocally hyperacute T-wave in lead aVL and I.  Precordial leads support the diagnosis of STEMI, showing posterior STEMI.

So this young person with syncope and no other symptoms is having a STEMI?

Could it be that this is his abnormal baseline ECG?

NO.

There is no baseline abnormality which looks like this.

There is a condition of baseline inferior ST elevation ("early repolarization" in the limb leads).  We have shown that this never has reciprocal ST depression.  Here is the reference


      Bischof J.  Thompson RP.  Tikkanen J.  Porthan K.  Huikuri H.  Salomaa V.  Smith SW.  ST-segment depression in lead aVL differentiates benign ST elevation from inferior Acute STEMI.  ACEP Research Forum 2012.  Annals of Emergency Medicine 60(4 Suppl):S8-S9; October 2012.

The patient was taken for PCI of 100% thrombotically occluded RCA. 

Later, his baseline abnormal ECG was obtained.  Here it is?
This is classic "Benign T-wave Inversion"

To learn all about Benign T-wave inversion, read this .
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