The Interventionalist Refuses Angiography, and even to speak to the Emergency Physician – repeat ECG pain free

In the ECG Quest archives, this ECG has been tagged with: - Chest pain Inferior ST elevation Peaked T waves Reciprocal ST depression ST elevation in V1 Right ventricular MI 12-Lead Dr Smith's ECG Blog CC BY-NC

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This ECG is from a middle aged patient who presented with chest pain of uncertain duration. This was the repeat ECG when pain returned.

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The Interventionalist Refuses Angiography, and even to speak to the Emergency Physician – repeat ECG pain free

This ECG shows ST elevation in V1, II, III and aVF with reciprocal ST depression in aVL. The cause was a proximal RCA occlusion. The T waves were peaked but the potassium was normal.

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Rate
Regularity
QRS width
Absent P waves
Anterior ST depression
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Asymmetrical P in V1
Biphasic T waves
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Cabrera's sign
Capture beat
Changing Axis
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Normal P waves
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Normal rate
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ST elevation in aVL
ST elevation in aVR
ST elevation in III>II
ST elevation in posterior leads V7-9
ST elevation in V1
ST elevation in V4R
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Non-sustained VT
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Sinus arrest
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Second degree AV block Mobitz type 2
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Ventriculophasic sinus arrhythmia
Acute right heart strain
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Beta blocker toxicity
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Brugada syndrome type 3
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Cardiac T-wave memory
COPD
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Coronary artery spasm
CVA
Dextrocardia
Digoxin effect
Digoxin toxicity
Dilated cardiomyopathy
Electrolytes
Familial catecholaminergic polymorphic ventricular tachycardia
Hypertrophic cardiomyopathy
Hypercalcaemia
Hyperkalemia
Hyperthermia
Hyperthyroidism
Hypertrophy and enlargement
Hypocalcaemia
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Hypomagnesaemia
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Juvenile T wave pattern
Lead misplacement
Left atrial enlargement
Long QT syndrome
Lown Ganong Levine syndrome
LV aneurysm
LVH
Metabolic acidosis
MINOCA
Myocardial Bridging
Myocardial rupture
Myocarditis
Normal
Normal ST elevation
Pericardial effusion
Pericarditis
Propranolol toxicity
Pulmonary embolism
Pulmonary and Pericardial
Quetiapine toxicity
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Restrictive cardiomyopathy
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Abdominal pain
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Introduction
12-Lead
Recording a 12-Lead ECG
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LA/LL electrode reversal
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Movement artefact
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Rhythm Strip
Right leads
Serial 12-lead
Systematic Interpretation
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Double speed 50 mm/sec

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