Profound ST depression in II, III, aVF

Conclusion:Type II MI probable due to hypoxia and tachycardia from resp arrest and amphetamine use.  Whether the ST Depression on the ECG represents ischemia or not is uncertain, but it does not represent acute coronary syndrome.===================================MY Comment, by KEN GRAUER, MD (7/26/2023):===================================The most interesting aspects of today ’s case are: i) The tale told by the 6 ECGs; and, ii) The surprise finding of positive troponins! The Sum is More than Each of its Parts:If we look back at the initial ECG in today ’s case — it’s easy to let one’s attention be “captured” by the inferior lead ST depression (especially the “eye-catching” sharp and deep descent of the ST segment in lead III) + the mirror-image opposite shape of the ST elevation (with overly straight ST segment take-off) in lead aVL. Under most circumstances — this combination of ECG findings would point to an acute event. But — the sum of this initial ECG is more than each of its parts. Regarding specifics of this initial ECG:QRS amplitude in multiple leads is huge! Even though I did not know the patient ’s age at the time I saw this initial tracing — it was obvious that voltage for LVH would be easily satisfied. The lateral chest lead ST depression (with terminal T wave inversion in le...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs