We’ll skip the preamble and jump right to the EKG this week.
Much of this EKG is fairly straightforward. Rate is in the 70’s, there’s pretty plain P waves in appropriate places so this is normal sinus rhythm. The P wave borders on biphasic in V1. Axis is probably normal, the QRS is slightly isoelectric in I, and upright in aVF. QRS is nice and narrow. There are some generous voltages in V2 and V5, totaling over 7 big boxes of voltage when added up so he may have LVH.
Let’s talk about the ST waves. A couple of you commented on possible STE inferiorly, to my eyes I think that is more a matter of the baseline slowly dropping. If you compare the J point to the initial section of the T-P segment I think it looks re-assuring. The chest leads are a different story however. The ST wave is biphasic in V2, mildly biphasic in V3, and inverted in V4. This is the pattern shown in Wellen’s Syndrome, a repolarization abnormality indicative of a critical LAD lesion, a pattern you need to recognize to prevent a large MI.
In this patient however? Well he was observed in the CPU and had an echo … which was normal. He had a nuclear stress test … which was normal. He’s still following with cardiology but looks like he may not actually have the stenosis he could have had given the EKG. It’s still a pattern worth keeping on your radar since even though this patient may not have the serious underlying pathology the next patient might.