The computer calls this a “normal ECG”. We ' ll just keep making this point.

This case was contributed byBrooks Walsh, an emergency physician in Connecticut.A middle-aged woman had an acute onset of chest pain and dyspnea. The symptoms improved somewhat after the paramedic gave her nitroglycerin. The pain had almost resolved by the time an ECG was obtained in the ED:Here is the computer diagnosis What do you think?Perhaps you might think these changes are too subtle to immediately call for the cath lab. But do you think the ECG is “normal?” Well, the computer thought so!Note leadsIII and aVF. There is subtle ST segment elevation in those leads. Although it is not high in absolute terms, it is quite high relative to the low QRS voltage in those leads. In combination with the subtle ST depression in aVL, these changes are diagnostic for, or at least nearly so, for acute occlusion of a coronary artery, probably with some reperfusion, as inferior T-waves are inverted and the T-wave in aVL isreciprocally upright.Despite the computer interpretation, the ED physician was concerned about the ECG, and planned for serial troponins.The first level was undetectable.  Three hours later, however, the troponin I was elevated at0.08 ng/ml(99th percentile 0.01 ng/ml). The patient was verified to be symptom-free, and a repeat ECG was performed.Note that the ST elevation in the inferior leads has basically resolved, especially compared with the restored QRS voltage. The ST depression in aVL is also resolved.This confirms that there were dynamic signs ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs