Not Your Usual STEMI: High Voltage and Narrow Q Waves

ECG Weekly Workout with Dr. Amal Mattu

HPI

A 16-year-old male is referred to the emergency department from a primary care clinic with concern for STEMI. He has no known past medical history. At the clinic, he reported nonspecific chest pain, but upon arrival to the ED he is asymptomatic. The clinic ECG, interpreted by the computer as inferior STEMI, is shown below:

Before watching this week’s workout, review the ECG and consider:

    1. Based on this tracing alone, are you concerned for an acute STEMI? Why or why not?
    2. Which specific ECG features support or argue against infarction? Consider Q-wave width and depth, lead distribution, ST segment changes, and overall voltage.
    3. In an asymptomatic 16-year-old, what alternative explanations could account for this pattern, and what single test would you order next to confirm your leading diagnosis?