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A prior ECG from 1 month ago was available: The presentation ECG was interpreted as STEMI and the patient was transferred emergently to the nearest PCI center. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of suddencardiacdeath. So maybe she is better than I am.
2) The STE in V1 and V2 has an R'-wave and downsloping ST segments, very atypical for STEMI. Cardiology was consulted and they agreed that the EKG had an atypical morphology for STEMI and did not activate the cath lab. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. Bicarb 20, Lactate 4.2,
Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had suddencardiacarrest in sleep. Twenty-one percent (18 of 88) had a family history of suddencardiacdeath and 26.4% (14 of 53) carried a pathogenic SCN5A mutation. And another finding.
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