A middle aged male with h/o CAD presented with chest pain. He had a recent previous stent in the circumflex. Here is the ECG at time = 0
What do you think?
Here is the previous ECG from one month prior
Now what do you think?
Now it is very clear that there is an acute posterior STEMI.
Notice the tall and large precordial T-waves. These are what I call Posterior reperfusion T-waves . They are the analog of Wellens' T-waves and if recorded from the posterior wall would look like Wellens' T-waves. But because the leads are over the anterior wall, then they are large and upright, rather than inverted!
Opiates in Acute Coronary Syndrome:
Opiates are associated with 1.5x mortality in ACS. Why? Probably because they lead the physician to a false sense of security. In this case, the absence of any further chest pain was reassuring to the physicians.