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.”