ECG Review
A Patient with Chest Pain
By Ken Grauer, MD, Professor, Department of Community Health and Family Medicine, University of Florida. Dr. Grauer is the sole proprietor of KG-EKG Press, and publisher of an ECG pocket brain book.
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Clinical Scenario
The ECG shown above was obtained from a patient who was seen in the office with atypical chest pain. Is there cause for concern?
Interpretation
The rhythm is sinus at a rate of about 60/min. The axis and all intervals are normal. There is no chamber enlargement. The principal findings of concern are the subtle but definitely present ST-segment depression in each of the inferior leads that occurs in association with equally subtle but nevertheless present ST-segment elevation in lead aVL. There is non-specific ST-segment flattening in several other leads. This tracing provides an excellent example of how shape more than amount is often the key for assessing the significance of ST-T wave changes. While the amount of ST-segment deviation is minimal in this tracingthe pattern of changes seen here in a patient having chest pain could reflect acute evolving infarction (or perhaps a later phase in a patient who recently infarcted). Clinical correlation and comparison with prior tracings would be invaluable for clarifying the situation. A final point is the fact that the remote high lateral lead aVL can at times be the only lead showing ST-segment elevation with acute infarction.
The ECG shown above was obtained from a patient who was seen in the office with atypical chest pain. Is there cause for concern?You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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