Chest Pain Diagnosed as Gastroesophageal Reflux

p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.0px Helvetica; background-color: #fefefe}A 50-something male presented to a clinic for one day of intermittent substernal chest and jaw pain. He had had several episodes of pain since onset; it was described as pressure-like and lasts about 5-15 minutes and resolves spontaneously. He had been pain free for about an hour.  He had some " pre-diabetes, " but no h/o hypertension, no known family history of heart disease, and he smokes about 1-2 cigarettes per day. An ECG was recorded:The computer read:Normal ECGWhat do you think?Smith Comment:This is definitely not a normal ECG.There is less than 1 mm of ST depression in II, III, aVF, and in V3-V6.The STD is nearly 1 mm in III and V6.There is a tiny amount of ST Elevation in aVLTheST vector is around -60 degrees, so that there is some STE in aVL and a bit in I, and zero in aVRWhat is a normal ST segment?--First, one must be sure that the QRS is normal. An abnormal QRS (abnormal depolarization), such as in LBBB, LVH, RBBB, or RVH, may result in abnormal ST-T (abnormal repolarization). In this case, theQRS is normal: normal axis, duration, and amplitude, without abnormal Q-waves.When the QRS is normal--The normal ST vector is towards leads II and V5 (anterior and leftward)--Leads I, II, and aVF should not haveany ST depression, as the normal ST vector is leftward and anterior. It is common to have some normal variant ST elevation in th...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs