The Daily PANCE and PANRE Question 47

A 48-year-old male presents with crushing chest pain for 45 minutes. He is diaphoretic, nauseous and short of breath. His EKG demonstrates 4 mm of ST segment depression in leads I, aVL, V5, and V6. What is the most likely diagnosis?

  1. esophageal spasm
  2. a hiatal hernia
  3. acute lateral wall subendocardial myocardial ischemia
  4. acute inferior wall myocardial subendocardial ischemia
  5. acute anterior wall myocardial transmural ischemia

Answer: C

Acute lateral wall subendocardial myocardial ischemia

It is obvious this patient is having an AMI. The ECG lead abnormalities suggest occlusion of the high lateral and low lateral walls of the LV - typically supplied by the circumflex - there are no Q waves - so subendocardial. Inferior AMI is leads II, III, avF. Anterior wall AMI is leads +/- VI, with V2-V4, and maybe V5 & V6.

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