Four ECGs Hiding a High-Risk Coronary Pattern

ECG Weekly Workout with Dr. Amal Mattu

HPI

A 56-year-old man presents with 1 week of concerning chest pain and shortness of breath. His ECG does not meet conventional STEMI criteria, but it shows subtle ST-segment abnormalities in lead III, V1, and the lateral leads.

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

    1. What specific ECG pattern should be considered?
    2. Why can this pattern be missed by both clinicians and computerized interpretation?
    3. What coronary anatomy and clinical risk are associated with it?
    4. Should the absence of contiguous ST-segment elevation reassure you?