A 60 year old with chest pain

CONCLUSION:Take another LOOK at Figure-1. It was after Dr. Smith suggested repeating the initial ECG after repositioning the LL electrode — that ECG #2 was recorded.In your mind ' s eye — Wouldn ' t ECG #1 look like ECG #2 if we took away the artifactual deflections highlighted in RED, BLUE and GREEN?That said — there is nonspecific ST-T wave flattening in multiple leads of ECG #2, as well as T wave inversion in lead V2. There are also fairly large U waves in leads V3 and V4. Finally — significant baseline artifact persists in leads II and III of ECG #2, suggesting there may still be some patient movement localized to the left leg.MY Impression of ECG #2: Keeping in mind that the patient in today ' s case presented with chest pain — the nonspecific ST-T wave flattening in multiple leads, with T wave inversion in lead V2 could be ischemic — albeit clearly not suggestive of an acute event! Serum K+/Mg++ levels need to be checked — as hypokalemia/hypomagnesemia are common causes of nonspecific ST-T wave flattening with U waves.Finally  — Did YOU Notice that there is no longer alternate beat variation in the long lead II baseline,nor in ST-T wave morphology. MY Theory: Given that we know the source of ST-T wave artifact in ECG #1 arises from the LL extremity — I suspect the t...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs