ECG case series for paramedics: September 2023

A 57-year-old man was admitted with sudden onset of severe central chest pain at rest. The pain was heavy in nature and radiated to both arms. He was sweaty and nauseous. His wife called for an ambulance.

He has a past medical history of type 2 diabetes, hypertension and transient ischaemic attack. The 12-lead electrocardiogram (ECG) in Figure 1 was recorded.

There is ST segment elevation isolated in lead III and ST depression in V4–V6. This ECG displays the characteristics of Aslanger's ECG.

Standard guidelines for primary percutaneous coronary intervention (PPCI) or thrombolysis have historically required contiguous ST-segment elevation to fulfil ST segment elevation myocardial infarction (STEMI) criteria, i.e. changes are present in two or more adjacent leads.

In April 2020, Aslanger et al (2020) reported a new specific ECG pattern indicating inferior myocardial infarction (MI) that does not display contiguous lead changes. Over 13% of inferior MIs may present with Aslanger pattern, and could therefore be incorrectly labelled as a non-STEMI (NSTEMI) and denied PPCI.