A 30-something Man with Chest Pain and this ECG

 ===================================MY Comment by KEN GRAUER, MD (11/10/2020):===================================A 30-something man presented in agony holding his chest. He thought the pain was due to esophageal reflux. The patient ’s initial ECG in the ED is shown in Figure-1.The rhythm is sinus. There appears to be ST elevation in each of the inferior leads. (The computer interpretation said, " Marked ST elevation; Consider inferior Injury " ...).QUESTION: Would YOU activate the cath lab? Figure-1: The initial ECG in this case (See text).Dr. Smith: I saw this patient when he arrived at triage, ordered the ECG — and placed the patient in a room. Then I went back to triage.  One of my partners was in the room when the ECG was recorded — and he was immediately concerned about possible inferior OMI.  He asked my opinion:Dr. Smith ' s Thoughts:" This just does not look right.  I don ' t think it is OMI. There is very strange morphology — and there is no reciprocal ST depression in lead aVL.It is some sort of artifact— but I don ' t know what kind.  I would order serial ECGs and rule out with troponin. "The Case Continued:Being comfortable that ECG #1 did not represent OMI, but instead had to be some type of artifact — Dr. Smith repeated the ECG 15 minutes later (Figure-2). He sent both tracings in Figure-2 to me.WHAT has happenedin the 15 ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs