October 22, 2019

Is this a STEMI?

Is this concerning for a STEMI? Maybe something else...

A 40yo with no significant medical hx c/o sudden onset dyspnea.

The ecg shows sinus tachycardia ~130's, there is S in lead I, Q wave and T wave inversion in lead II (or S1Q3T3 pattern) and diffuse T wave inversion in the precordial leads. This ecg pattern together with the short vignette is concerning for pulmonary embolism (PE).

CT angio showed bilateral PE with heavy clot burden and positive lower extremity DVT.

Medical management initiated and was discharged after a few days.

If you find yourself diagnosing inferior infarction from the limb leads, and anteroseptal damage or infarction from the chest leads, think of pulmonary embolism.” – Marriot’s Practical Electrocardiography 5e.

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