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6 Min Read

onApril 22, 2019

A 40 yo with Chest pain. Only ECG abnormality is minimal ST depression in I and aVL (computer interpretation: normal)

A former resident sent this. He asked: “Hey Steve, Wanted to get your thoughts on this EKG:” What do you think? The computer…

8 Min Read

Pendell Meyers

onNovember 12, 2018

Two cases texted to me for concern of inferior hyperacute T waves and a flipped T in aVL – do either, neither, or both need emergent reperfusion?

Written by Pendell Meyers I received two texts recently, in both cases the practitioners were worried about possible inferior hyperacute…

5 Min Read

Steve Smith

onJanuary 28, 2018

Is this ECG diagnostic of coronary occlusion? Also: Inferior de Winter’s T-waves on prehospital ECG??

This post was written by one of our fantastic Hennepin County Medical Center Emergency Medicine interns who is an ECG whiz, Daniel Lee. A man…

2 Min Read

Steve Smith

onDecember 29, 2017

Prehospital ECG looks very suspicious to the paramedic

This was sent by an anonymous paramedic. “One of the paramedics at my work approached me the other day and asked for my opinion on two…

4 Min Read

Steve Smith

onAugust 1, 2017

ST Elevation in I and aVL: do prehospital cath lab activation on these cases?

Case 1. A 50-something year old man with 2 cardiac risk factors had a syncopal episode associated with diaphoresis. There was no chest…

1 Min Read

Steve Smith

onFebruary 23, 2012

Reciprocal ST depression in II, III, aVF. What is the diagnosis?

A colleague approached me with this ECG of a middle aged male with this ECG; my colleague was worried about acute ischemia. There was no…

2 Min Read

Steve Smith

onDecember 27, 2011

Subtle Lateral ST elevation. False positive. This diagnosis is hard.

Case 1. A middle-aged woman presented with severe substernal crushing chest pain radiating to the left shoulder. This was her…

Scott Joing

onMay 28, 2011

Pericarditis vs. MI #2

2 Min Read

Steve Smith

onOctober 26, 2010

Tachycardia must make you doubt an ACS or STEMI diagnosis; put it all in clinical context

This 54 year old patient with a history of kidney transplant with poor transplant function had been vomiting all day when at 10 PM he…

2 Min Read

Steve Smith

onJuly 4, 2010

Inferior ST depression in ACS is reciprocal to ST elevation in aVL

For this topic, see also this post: https://drsmithsecgblog.com/2009/01/st-depression-limited-to-inferior-leads.html This 72 yo male with h/o…

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reciprocal ST depression

A 40 yo with Chest pain. Only ECG abnormality is minimal ST depression in I and aVL (computer interpretation: normal)

Two cases texted to me for concern of inferior hyperacute T waves and a flipped T in aVL – do either, neither, or both need emergent reperfusion?

Is this ECG diagnostic of coronary occlusion? Also: Inferior de Winter’s T-waves on prehospital ECG??

Prehospital ECG looks very suspicious to the paramedic

ST Elevation in I and aVL: do prehospital cath lab activation on these cases?

Reciprocal ST depression in II, III, aVF. What is the diagnosis?

Subtle Lateral ST elevation. False positive. This diagnosis is hard.

Pericarditis vs. MI #2

Tachycardia must make you doubt an ACS or STEMI diagnosis; put it all in clinical context

Inferior ST depression in ACS is reciprocal to ST elevation in aVL