38 year old male presents to the ER for chest pain. VS normal. No history. Was doing bench presses when it started. He is well appearing. The question is: Is this a STEMI? If you look closely at the EKG, you will notice ST elevation in V1, V2, but no reciprocal changes. The machine will often times flag this as a STEMI, but it is not. Isolated ST elevation in V1, V2 only with the “ski slope” formation seen here is classic Brugada Pattern type I. V1 and V2 are what I like to refer to as the “money leads”. A lot of action can happen in V1 and V2. HOCM can be seen here. Wellens can be seen here, and so can Brugadas. Look carefully for the ski slopes of brugadas.

by Jennifer Carlquist, PA-C

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