Look at this ST Depression

DiscussionAtrial repolarization waves are recognized by a downsloping PR segment and are a common cause of false positive stress tests.  They are augmented by tachycardia.See this paper:Sapin PM et al. Identification of false positive exercise tests with use of electrocardiographic criteria: a possible role for atrial repolarization waves. JACC 18(1):127-35; July 1991.  (link is full text)Link to abstract: http://www.onlinejacc.org/content/18/1/127.abstractHere is a schematic from my book,The ECG in Acute MI (this is a link to a free pdf)Learning Points:1. Recognize the atrial repolarization wave.  It can mimic ST depression.2. A patient with chest pain who takes a run while symptomatic and feels well during his run is unlikely to have ACS or pulmonary embolism.3. Look for the QRST angle4. The problem of the atrial repolarization wave is one of the reasons why the guidelines suggest that measuring ST Elevation should be at the J-point, relative to the PQ junction, NOT relative to the TP segment.In fact, there is no validated way to measure the ST segment that is highly sensitive and specific for Occlusion Myocardial Infarction.Here is more on the atrial repolarizaton wave.Here is more on the QRST angle===================================MY Comment, by KEN GRAUER, MD (10/2/2019):===================================I love this post for a number of reasons. Dr. Smith emphasizes the important (and often overlooked) point about how the atrial&...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs