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Spontaneous Circulation: Myocardial Infarction with Dual Culprit Lesions

Bruen, Charles MD

doi: 10.1097/01.EEM.0000433394.23022.00
Spontaneous Circulation

Dr. Bruen is a fellow in critical care medicine and emergency cardiology at Hennepin County Medical Center in Minneapolis. He has special interest in stabilization, resuscitation, hemodynamic evaluation, and emergency cardiovascular care.

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A 59-year-old man without prior cardiac history presented with three hours of severe upper sternal chest pressure that radiated to his throat, which he described as “strangulating.”

An ECG was obtained, and is shown here. It demonstrates a sinus rhythm at rate of approximately 75 bpm. The PR and QT intervals are normal.

There is a concerning 1 mm of ST-elevation in V5 and V6 with ST-segment depression in V2 and V3, suggestive of a posterior myocardial infarction. What is your diagnosis?

Find the diagnosis, a complete case discussion, ECG interpretation, and the patient's outcome by reading Spontaneous Circulation in EMN's iPad App on Aug. 7 or in the Spontaneous Circulation blog at, where additional EKGs are also available.

Click and Connect! Access the links in EMN by reading this issue on our website or in our iPad app, both available

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