Dynamic ST Change in a mid-50s Man with Chest Pain

===================================MY Comment by KEN GRAUER, MD (8/21/2020):===================================The patient is a mid-50s man who presented to the ED for new-onset chest pain of ~1 hour duration. His symptoms awakened him from sleep. He was still having chest pain in the ED at the time ECG #1 was done (Figure-1).QUESTION:HOW would YOU interpret his initial ECG that is shown in Figure-1?Figure-1: The initial ECG in this case (See text).MY THOUGHTS on ECG #1: Although significant baseline artifact is seen (especially in the limb leads) — the tracing is clearly interpretable. The rhythm is sinus at ~80-85/minute — the PR, QRS and QTc intervals are normal — and the frontal plane axis is normal (about +50 degrees).There is lots of voltage in the chest leads (ie, The R wave in lead V5 =25mm satisfies voltage criteria for LVH).Transition occurs normally between leads V2-to-V3 — albeit transition from a negative-to-a-positive complex is abrupt, with dramatically increased R wave amplitude (~30 mm) already seen in lead V3.There are small and narrow Q waves beginning in lead V3 — and continuing through to lead V6 (with small q waves also seen in leads I and aVL).The most concerning finding in ECG #1 relates to T wave morphology — especially for the T wave in lead V2 that clearly appears to be disproportionately tall w...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs