I saw this ECG only after the patient was discharged....

I was reading ECGs on the computer system when this one came up:What do you think?There is apparent ST elevation in III, with reciprocal ST depression in aVL.  At first glance, it looks like an inferior STEMI.It also has a wavy pattern reminiscent ofhypokalemia.  See these cases:Prehospital Ventricular Fibrillation in a Young Woman. What is the Diagnosis?But it looks very bizarre.  And I knew why. I looked to see what the patients symptoms were, and she was a 30-something woman with symptoms listed as " chest burning. "Then I saw that..... It was I who had seen and discharged this patient! It turns out she had complained to me only of cough and SOB, and had an asthma exacerbation, and we (I and an advanced practice provider) had treated her for an asthma exacerbation.  Her chest burning was only during coughing.  I had not known that she had an ECG recorded in triage.The computer diagnosis was " Non-specific ST-T abnormality. "  We immediately show all ECGs to faculty physicians in triage, but somehow this one did not get seen.It had not occurred to me that she needed an ECG, and so I had not looked to see if she had had one.The advance practice provider who was primarily responsible for the patient had not noticed the ECG abnormality.So look at the ECG closely:The 2 most bizarre leads are leads I and III.  aVR, aVL, and aVF also have ST-T abnormalities.But lead II is completely normal.How is this possible?Only if there is art...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs