D Brim
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Tough EKG to do anything with 100% certainty. I for one would never blame someone for talking a poorly controlled diabetic with a complaint of shortness of breath and an ugly looking 12-lead into going in for further evaluation. For that matter, I would personally try to talk anyone with a blood sugar of 450 into seeking out immediate care regardless of other complaints! Peripheral nerves and vasculature are being turned into those little cubes of sugar with ever passing minute!
That being said, I'm in the LVH with normally discordant ST deviations camp. It was mentioned that the 12-lead doesn't immediately appear to meet criteria for LVH. I presume that's referring to the the strongest EKG criteria, the ole' adding up S waves and R waves. Bottom line about LVH is that you can't count on EKG criteria to diagnose it, you really only know for sure based on echo (to the best of my knowledge, not a Doc here!). However, there are other, less convincing but still legit, EKG criteria for LVH. One of these criteria is a tall (> 11 mm) R wave in aVL, which the EKG demonstrates.
The other thing to keep in mind is AHA criteria for STEMI make allowances for a little STE in V2-V3, 2 mm in men, and 1.5 mm in women. The baseline is a little tricky in the septal anterior leads, but by my best estimate, you've got at most 2 mm in V1 and 1.5 mm in V2. So, you've got one of your two congruent leads that is bad enough to be concerned about, the other is very borderline. They don't really add up to warrant a text book defined STEMI.
That being said, I'm in the LVH with normally discordant ST deviations camp. It was mentioned that the 12-lead doesn't immediately appear to meet criteria for LVH. I presume that's referring to the the strongest EKG criteria, the ole' adding up S waves and R waves. Bottom line about LVH is that you can't count on EKG criteria to diagnose it, you really only know for sure based on echo (to the best of my knowledge, not a Doc here!). However, there are other, less convincing but still legit, EKG criteria for LVH. One of these criteria is a tall (> 11 mm) R wave in aVL, which the EKG demonstrates.
The other thing to keep in mind is AHA criteria for STEMI make allowances for a little STE in V2-V3, 2 mm in men, and 1.5 mm in women. The baseline is a little tricky in the septal anterior leads, but by my best estimate, you've got at most 2 mm in V1 and 1.5 mm in V2. So, you've got one of your two congruent leads that is bad enough to be concerned about, the other is very borderline. They don't really add up to warrant a text book defined STEMI.