UMMC Cases Part I: Three ECGs That Reward a Second Look

UMEM Potpourri ECG Cases with Dr. Amal Mattu

HPI

A 62-year-old man presents with chest pain during a busy emergency department shift. His triage ECG is interpreted by the computer as showing ST-segment depression and possible ischemia. The tracing demonstrates ST-segment depression in leads V1 through V3, relatively tall anterior R waves, and subtle abnormalities in the inferior and lateral leads. There is no obvious ST-segment elevation on the initial standard 12-lead ECG.

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

    1. Do the anterior ST-segment depressions represent anterior ischemia, reciprocal change, or something else?
    2. What additional ECG leads should be obtained?
    3. Which subtle QRS to T wave abnormality may provide an early clue that this is an acute coronary occlusion?