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:
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.