Some ECG simply require pattern recognition, followed by a bit of investigation

Brooks Walsh @BrooksWalsh helped with this post One of my partners showed me this series of ECGs, without any info:I said: " It ' s a normal variant.  Young black male, right? "He said, " Yes, but look at this one recorded 2 hours later. It is different " :There is T-wave inversion in V4 that was not there before.I said: " Yes, small changes can happen even with normal variants. "  And there might be a slight difference in lead placement.  On the 2nd ECG, V4 is farther to the right -- notice there is more S-wave than on the first and the R/S ratio is smaller.  There was also a 3rd ECG at 3.5 hours:Same issue here: V4 is even farther right, and R/S ratio = 1I said " So tell me about the patient.  Chest pain?  Young black male? "" Yes, 33 yo black male with acute chest pain. "Then I said, " I would just rule him out with troponins. "He said: " He had 2 hs troponin I less than 4 ng/L. "I said, " Then that is all you need. "He said, " Well, I called cardiology and got a formal echocardiogram.  It was totally normal.  How did you know? "I said, " First, there is very high voltage, probably because he has thin chest wall and, second, I recognize this morphology.  Some things simply require pattern recognition. "Comments  T-wave inversion, with or without ST Elevation, in young black males, especially athletes, is very complicated, but not so much because it mimics ACS, but because it is difficult to ascertain if the E...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs