Looking through a stack of ECGs for a troponin study.....

And I came across this one while reading EKGs for a high sensitivity troponin study:what do you think?Normally, if one sees STE in aVL with reciprocal STD in III, one would say " Acute OMI " .But I instantly knew it was not.I immediately recognized it as normal, and classified it for the study (blinded) as " normal with normal ST Elevation and " normal ST depression. "More on this ECG:All I know when I see the ECG for this study is that the patient has had at least 2 troponins drawn.I don ' t know whether it is for chest pain, weakness, whatever.I don ' t know for certain why my (our) mind immediately knows that it is normal.I believe it is partly the flat STE, lots of upward concavity in the STE so that T-wave does not look hyperacute (hyperacute T-waves are " fat " because there is less upward concavity).But there is terminal QRS distortion, which in a large study I just did I found to be quite good for OMI.The ST axis is barely negative in aVF and slightly positive in II, so it is about -10 degrees, and I ' m not sure what to make of that.I sent it to Ken Grauer and he knew it was not as well.This is what he wrote:Hi. I ’ll assume “CP” for the history.Sinus rhythm. Assuming it ’s an adult at least ~35, then the deep S and ST-T wave shape in V2 suggest LVH.There is J-point ST elevation in I, aVL. Lead III shows some ST dep with T inversion — but given ONLY seen in lead III (aVF is flat) — I am NOT at all convinced this is necessarily acute!I ’d want more info,...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs