John Bielinski, MS PA-C 
A 54-year-old type 2 diabetic is getting admitted to the hospital for ischemic chest pain. The ER
physician noted inferior wall ischemia, as noted above. Patient received aspirin and had one
inch of Nitro glycerin on yet still had two out of 10 chest pain. Initial troponin was negative.
What is your next step?
Answer to the Critical Thinking Clinical Case of a 54 yo DM with CP
Note V1 and V2 on the 12 lead EKG:
There is elevation in both leads. And, with depression in the inferior leads. Could this be a
septal STEMI? The next best move is, a second EKG.
Remember, an EKG is a static picture in time, and a STEMI is a dynamic process.
Follow up EKG:
Note the elevations in V1 and V2 are more pronounced. This patient went immediately to the cath lab.
