You gotta believe

It’s all too easy sometimes to argue oneself out of the correct answer.  Sometimes we get distracted by red herrings, sometimes a picture can just be very complex.  However, sometimes the answer is there but we just can’t quite bring ourselves to believe it.  Let’s look at this week’s EKG:

~30 y.o. man with chest discomfort

He’s young.  Surely there can’t be anything seriously wrong could there?

Rate is normal, in the 60’s.  There is some sinus arrhythmia, as evidenced by the shorter RR interval between the first 2 beats than the others.  Otherwise it’s pretty obvious sinus rhythm.  The axis is probably normal, up in I though fairly isoelectric in aVF.  The QRS is pretty unremarkable.

On to the ST waves.  Let’s zoom in on aVL


There’s clearly T wave inversion, there’s also subtle ST depression suggested as well.  Going along with this let’s look at the lateral chest leads:


I know he’s young, but this just isn’t normal.  There’s ST depression here.  While it’s tempting to have young people follow-up as an outpatient, young people should have normal EKG’s.  We see a lot of non-specific T wave abnormalities because we do a lot of EKG’s in older patients, many of whom have heart disease.  This patient … had heart disease and had a 99% lesion in his RCA stented the next morning.

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