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He’s Young; it CAN’T be a STEMI!

SBHPP Speaker - Jennifer Carlquist
By: Jennifer Carlquist, PA-C, ER CAQ

This is a 38-year-old male presents to the ER for non -exertional chest pain. He was doing bench presses when it started. He is well appearing. His vital signs are normal.

The question is: Is this a STEMI? If you look closely at the EKG, you will notice ST elevation in V1, V2 but no reciprocal changes. The machine will often flag this as a STEMI, but it is not. Isolated ST elevation in V1, V2 only with the “ski slope” formation seen here is classic Brugada Pattern type I. Brugadas is a channelopathy caused by a genetic mutation that can lead to VF and VT, and this can lead to cardiac arrest.

I like to call V1 and V2 the “money leads” because a lot of action can happen in V1 and V2. For example, Wellens can be seen here, and so can Brugadas.
In a case where the machine reads STEMI, and there is only isolated ST elevation in v1 and v2, always look carefully for the “ski slopes of Brugadas.”

See Jennifer Carlquist, PA-C, ER CAQ speak at a 2021 Skin, Bones, Hearts and Private Parts CME Conference in DestinMyrtle BeachVirginia BeachChicagoPensacola BeachSan AntonioOrlandoAtlanta, or Las Vegas.