It’s my EKG

So to the jerk who told me I had poor R wave progression … well.  It will be reflected on your next eval.

Kidding of course.

42 y.o. man with occasional exertional CP, asymptomatic at present

Starting always with the rate, this looks to be low 70’s.  The lead II rhythm strip shows a clear P before each QRS and a QRS after each P so this is sinus.  Axis is normal, up in I and up in aVF.  QRS is narrow.

I was curious to see if anyone would bite on the J point elevation in V2 and V3.


It coves up which is reassuring, and we don’t see any reciprocal change elsewhere.  Remember though that ischemia does sometimes cove up and doesn’t always have reciprocal change.  A couple additional points help a person feel more comfortable that the J point elevation is simply early repolarization and not true ST elevation (aside from the asymptomatic state).  First, the J point is less than a quarter of the height of the ST wave.  Any J point elevation more than a quarter of the height of the the ST wave is much harder to ascribe to early repol.  The other thing to carefully define is what the baseline is.  Many patients, not just those with pericarditis, can have a little PR depression or depression before the P wave.


If the baseline of this EKG is the level indicated in red then 2 mm of STE in V2 becomes 1, and 1 mm of STE in V3 becomes zero.

This is a Normal EKG.  And while it was less interesting to you based on the overall number of responses, I promise you it was pretty interesting to me!

0 comments on “It’s my EKG

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