Reciprocal (Negative) Hyperacute T-waves. What is the Diagnosis?
Posted Aug 14 2012 5:10pm
I was shown this ECG and asked if I think it is a STEMI. What do you think?
I answered that it does not meet any criteria for STEMI, but that there are hyperacute reciprocal (negative) T-waves in I and aVL and this cannot be anything other than inferior STEMI, especially since the ST depression in V2-V5 suggests concomitant posterior STEMI.
The ECG findings resolved before cath. At cath, there was an 80% hazy thrombotic lesion in the RCA. Thus, this was indeed an acute RCA occlusion. Echo the next day showed an inferior wall motion abnormality.
Lesson: Reciprocal ST-T changes are often more pronounced than the ST-T changes overlying the affected myocardium. This is particularly common when there is lateral STEMI with inferior ST depression ( see these two cases ).