SSmith-DRAFT- What's Unusual-Inf. OMI-ST aVL (9-19.1-2022)-ME_TO_DO

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Comment by KEN GRAUER, MD (9/19/2022):

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Figure-1: The initial ECG in today's case. (To improve visualization — I've digitized the original ECG using PMcardio).

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SSmith DRAFT (as of 9/19/2022):

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This acute inferior posterior lateral OMI has a finding which is very rare.

When we studied inferior OMI, we found this in only 1% of cases.  In the cohort of 154 inferior OMI at Hennepin County Medical Center, there were 33 with ST Elevation in V5 and V6.  None of the 33 had this finding.

What is the rare finding?

Absence of reciprocal STD in aVL.  

In the diagnosis of inferior OMI, reciprocal STD in aVL is almost more important than STE in inferior leads.  Again, we found some amount, often less than 1 mm, in 99% of cases, and many of the cases had less than 1 mm of STE in the inferior leads.