wearing the green

It’d be even better if I had a posterior view of a bird wearing green…

White-tipped Quetzal, northern Colombia, 2023

But only front views of the bird, which I guess makes sense, since we get a front view of the heart…

60’s y.o. man s/p syncope

Rate is in the 60’s, P waves are easy to see; so this is sinus rhythm. Axis appears to be left. PR intervals seem normal. The QRS’s have low voltage though there can be many causes for that. The ST waves, especially pre-cordially, should draw the eye. There’s clear ST depression. Some of you commented that the shape of that depression could go along with a Salvador Dali scooped out T wave, and you’re not wrong to think about that. Usually that scooped out T wave’s J point will still be fairly normal in digoxin toxicity; today’s J points are depressed. Ischemia must be considered with ST depression, and indeed the anterior location of the changes mean we have to think about that view of the heart we don’t automatically get, the posterior view.

EKG a few minutes later with posterior leads in place of V4-6

Now we get the view of the heart that I couldn’t give you of the bird (and the bird’s a lot prettier). We see tombstones.

Take-homes from this patient with a Posterior STEMI? (And his syncope, by the way, was an aborted run of Vfib, should I have told you that?) It’s pretty obvious, just gotta consider posterior STEMI when you see ST depression “anteriorly.”