UMEM Cases, Part 1: When the ECG Lies and When It Evolves

UMEM Potpourri ECG Cases with Dr. Amal Mattu

HPI

A 72-year-old man presents with chest pain and shortness of breath. His ECG shows sinus rhythm with LVH, mild inferior ST elevation, and lateral ST-T abnormalities that some interpret as simple LVH strain rather than acute ischemia. A repeat tracing 15 minutes later does not show a dramatic new STEMI pattern, but it does show subtle evolution.

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

    1. When can lateral ST-T abnormalities reasonably be called LVH with strain, and when should that label make you uneasy?
    2. Why should isolated ST depression and T wave inversion in aVL make you more concerned than a typical lateral “strain” pattern?
    3. What subtle change on the repeat ECG would make you worry that this is not just LVH strain?