Subtle ST Abnormalities and a Difficult Cath Lab Decision

ECG Weekly Workout with Dr. Amal Mattu

HPI

A 60-year-old man presents with chest pain that seems a little better after belching, but his clinician is not reassured. The initial ED ECG shows subtle ST-segment abnormalities, the computer calls it nonspecific, and cardiology is not convinced. A repeat tracing is obtained 15 minutes later for ongoing pain.

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

    1. Would you activate based on the first ECG alone?
    2. If V2 is the most concerning lead, what other leads should you inspect closely?
    3. What reciprocal change helps confirm that this subtle pattern may be more dangerous than it first appears?