Chest pain

Terminal QRS distortion occurs when there is ST elevation and neither an S wave nor a J wave is present. This applies to either lead V2 or V3. This may suggest that LAD occlusion is more likely than normal variant early repolarisation. This sign is not well known and can be missed.

References

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In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST depression Acute Inferior MI Acute Posterior MI Serial ECGs & Dynamic Changes Dr Smith's ECG Blog CC BY-NC
A man in his 70s with chest pain during a bike ride 31934

This ECG is from a man in his 70s who presented with chest pain that started during bike riding.

This ECG shows subtle ST depression in V2-6 and ST elevation in III. He had multi vessel disease with a near-occlusive culprit RCA lesion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Flat T waves Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
Chest pain with NonDiagnostic ECG but Diagnostic CT Scan 31925

This ECG is from an elderly woman who presented with several hours of chest pain radiating to the back.

This ECG shows flat T waves in aVL but otherwise normal. Troponin was elevated. CT showed no dissection but an area of transmural ischemia. Serial ECGs showed no change. The cause was an occluded OM1.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Hypertension 12-Lead Discordant ST changes Tall QRS Wide QRS LBBB ST changes with LBBB Dr Smith's ECG Blog CC BY-NC
A 50-something woman with chest pain, BP 230/120, and LBBB with 7 mm ST Elevation 31864

This ECG is from a woman in her 50s who presented with chest pressure on a background of heart failure and hypertension. BP 223/125.

This ECG shows sinus rhythm, LBBB and anterior ST elevation. Sgarbossa positive but modified sgarbossa negative. Echo showed LVH, troponin did show a rise and fall, MIBI showed normal perfusion. The most likely cause was a type II MI. The ECG changes did not evolve and were likely baseline changes.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Chest leads Anterior ST elevation Hyperacute T waves Terminal QRS distortion Normal vs. abnormal anterior ST elevation Dr Smith's ECG Blog CC BY-NC
A 40-something healthy male with transient chest squeezing 31836

This ECG is from a man in his 40s who presented with intermittent chest tightness, shortness of breath and diaphoresis.

This ECG shows ST elevation in V1-6 and hyperacute T waves out of proportion to the size of the QRS. There is terminal QRS distortion in V3. The cause was an acute proximal LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST depression Inferior ST elevation Wide QRS LPFB RBBB Acute Inferior MI Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
Teach your learners: when the QRS is wide, the J-point will hide, so trace it down and copy it over! 31813

This ECG is from a middle aged man who presented with chest pain and diaphoresis while exercising. He had a VSD repair at age 6.

This ECG shows sinus tachycardia with RBBB + LPFB. ST elevation in III and aVF with reciprocal ST depression in aVL. ST depression in V2-5. The cause was inferoposterior MI, due to severe triple vessel disease and a culprit 100% circumflex occlusion.

In the ECGquest archives, this ECG has been tagged with: - Abdominal pain Chest pain 12-Lead Coved ST elevation Peaked T waves Tachycardia Wide QRS Sinus tachycardia Hyperkalemia Dr Smith's ECG Blog CC BY-NC
Do you recognize this ECG yet? 31724

This ECG is from a man in his 30s who presented with chest pain and RUQ abdominal pain, on a background of type 1 diabetes. His BSL was high.

This ECG shows sinus tachycardia with a wide QRS, R in aVR, coved ST elevation and peaked T waves. The cause was hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Hyperacute T waves Lateral ST elevation Reciprocal ST depression Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
The ECG was correct. The angiogram was not. 31341

This ECG is from a man in his 70s who presented with chest pain and nausea on a background of previous MI.

This ECG shows sinus rhythm with PVCs and subtle ST elevation in I, aVL and V2 and reciprocal ST depression in III and aVF. Angiogram was negative. The most likely cause was a brief LAD occlusion that spontaneously reperfused.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead ST elevation in aVR ST elevation in V1 Widespread ST depression Left main occlusion Dr Smith's ECG Blog CC BY-NC
How does acute left main occlusion present on the ECG? 31324

This ECG is from a woman in her 50s who presented with 3 days of intermittent chest pain that became worse on the day of presentation, with diaphoresis and radiation to the left arm, as well as abdominal pain.

This ECG shows widespread ST depression with ST elevation in aVR and V1-2, due to a 100% left main occlusion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Inverted T waves Acute right heart strain Pulmonary embolism Dr Smith's ECG Blog CC BY-NC
A young woman with altered mental status and hypotension: Case 2 31484

This ECG is from a patient of unknown age who presented with sudden chest pain and shortness of breath.

This ECG shows domed inverted T waves V1-3, consistent with acute right heart strain caused by Pulmonary Emboli.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST elevation Bifascicular block LAFB RBBB Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
What is the Diagnosis in this 70-something with Chest Pain? 31294

This ECG is from a man in his 70s who presented with chest pain.

This ECG shows RBBB, LAFB and ST elevation V2-4. The troponin was very high due to a very large infarct. The cause was 3 vessel disease. The rhythm is also grouped, possibly bigeminy.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Inverted T waves Myocarditis Dr Smith's ECG Blog CC BY-NC
What does this ECG with significant ST Elevation represent? 31285

This ECG is from a man in his 30s who presented with a week of chest pain.

This ECG shows T wave inversion in V5-6 with J point notching and a short QT interval. Echo showed global hypokinesis and mild-mod systolic dysfunction. Troponin was elevated. Angiogram was normal. The diagnosis was myocarditis.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Syncope 12-Lead Anterior ST elevation Pathological Q waves Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
A man in his 40s with chest pain and syncope after cocaine use 31283

This ECG is from a man in his 40s who presented with chest pain and syncope after cocaine use. He had pain at the time of this ECG.

This ECG shows ST elevation in V1-5 with Q waves anterior and inferior. Brugada-like morphology in V1. The cause was an anterior MI.

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