This 65 year old woman presented in cardiogenic shock:

Some will find this easy (if so, sorry!), but some might be confused.  See below.

Well, 2 cardiologists and one emergency physician thought that there was high lateral ST elevation with reciprocal ST depression in inferior leads.  They did not see that it was atrial flutter.  When you are tuned into reading atrial flutter, though, as I am, this is regognizable within seconds as atrial flutter.  The flutter waves distort the baseline and can make it appear to have ST elevation or depression.

Diagnosis: Atrial flutter.   There is no ST elevation or depression, only flutter waves that mimic ST deviation.

There was very poor LV function causing the shock, but made worse by poor filling due to atrial flutter with 2:1 block and a ventricular rate of 130.

The angiogram was completely normal.