EKG Challenge #4: 61 yo male with chest pain

61 year old presents to the ED with chest pain radiating to his ​​shoulder

What is the diagnosis?

Anterior STEMI
Elevations of the ST segments in the precordial leads. There are ST depressions (reciprocal changes) inferiorly (Green arrows), poor R wave progression (Red) and T waves that are more symmetric (yellow). Additionally the patient is 61 years old.

Why Not...

Why is this not Benign Early Repolarization?
The differentiation of benign ST elevations (BER) and Anterior STEMI can be difficult. There are a number of characteristics which are suggestive of BER vs. STEMI. Make sure to examine for other ischemic changes. Our job is to exclude MI and BER should be diagnosis of exclusion. Some features suggestive of each in below table.

Learn more

Consider using the Subtle Anterior STEMI calculator in cases where you are concerned, but the EKG may be difficult to decipher