ECG

M a r k s M a n S h i p #EMW2019 Cardiology Workshop

@HumanFact0rz

Case 1: 40M poorly controlled DM, agitation

ECG

M a r k s M a n S h i p

This is LM occlusion When your eye sees diffuse TW inversion LOOK AT aVR and V1

The combo of STE in aVR and V1 along with diffuse TWI is a badass STEMI

Case 2: 58F chest pain, now resolved

ECG

M a r k s M a n S h i p

Case 2: 58F chest pain, now resolved

aVR, V1 look fine Diffuse T-wave inversion DDx: Wellens syndrome (LAD occlusion) Apical hypertrophy LVH PPM Raised ICP

Case 2: 58F chest pain, now resolved (same patient, different ECG)

ECG

M a r k s M a n S h i p

Posterior Wellens Syndrome

Posterior leads are mirrored in anterior leads Posterior inverted T-waves will look peaked precordial T-waves

This is not a STEMI But if missed, a true posterior STEMI might be around the corner

STRAIN

Case 3: 42M non-ischemic sounding chest pain Is this anything?

ECG

M a r k s M a n S h i p

STRAIN in aVL

ISCHEMIC In aVL

QRS/T Angle: Difference between QRS and T axes as measured on the ECG -QRS/T angle > 100 = LVH, LBBB, Paced rhythm -Else suggests ischemia

Check out aVL in this inferior STEMI!

Often this will precede inferior ST elevation

References

1. Left main occlusion on ECG (a deep dive):

http://hqmeded-ecg.blogspot.com/2014/08/the-differencebetween-left-main.html

2. Posterior Wellens Syndrome: Emerg Med J 2017;34:119-123

3. aVL and the QRS-T angle:

https://www.ecgmedicaltraining.com/importance-of-leadavl-in-stemi-recognition/