Anterior ST Elevation and a Finding that was Overlooked

===================================MY Comment by KEN GRAUER, MD (11/19/2020):===================================I ’d like to revisit one of Dr. Smith’s ECG Blog posts from 2012 for 2 Reasons:Reason #1: It highlights the challenge of assessing anterior ST elevation in a certain type of patient.Reason #2: There is one more easy-to-overlook but important finding on the ECG that was not initially detected.TAKE a LOOK at the ECG in Figure-1. This is the initial tracing from this patient who presented to the ED with new chest pain and dyspnea.There is ST elevation in leads V1-thru-V3 of ECG #1, attaining 3-4 of J-point ST elevation in lead V3.QUESTION #1: Given the history (ie, new-onset chest pain)  — Should the cath lab be activated? IF not — WHY not?QUESTION #2: What other important finding in the limb leads should be recognized?Figure-1: The initial ECG in the case from our February 8, 2012 post in Dr. Smith ’s ECG Blog (See text).ANSWER to QUESTION #1: As discussed by Dr. Smith back in 2012 (and reinforced many times in the 8 years since on this Blog)  — the reason not to activate the cath lab based on the ECG shown in Figure-1  — is that this ECG is almost literally screaming, “The patient has LVH! "QRS amplitude is dra...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs