Subtle ECG findings of acute LAD occlusion

---and a look back through the retrospectroscope at Grunt Doc's patient who went to the cath lab with a normal ECG.


A mini lecture by Dr. Smith over at his wonderful ECG blog points out some of the subtle changes of early acute LAD occlusion. These are often patients who present very early, before classic “STEMI” changes develop. A look back at the tracing of Grunt Doc's patient who went to the cath lab with a “normal” ECG and turned out to have acute proximal LAD occlusion may show some of the subtle changes, particularly the “fat” upright anterior precordial T waves, longish QT and poor R wave progression, findings which rule against benign early repolarization.


Sometimes in difficult cases such as this a repeat tracing only moments later may reveal diagnostic ST elevations. Grunt Doc's tracing was not diagnostic and no one would be criticized for not shouting “STEMI.”