The Patient: This ECG was taken from a 73-year-old man with a history of heart failure with preserved ejection fraction, severe left ventricular hypertrophy, Type II diabetes, and stage 4 chronic kidney disease. The ST depression in the inferior wall is most likely reciprocal. After the offending artery was opened and stented, the wide complex became narrow and was considered to be an interventricular conduction delay that was due to the ischemia. However, it doesn’t have the “look” of LBBB with the low-voltage seen in the anterior wall. The wide QRS meets the criteria for left bundle branch block (wide QRS, negative QRS in V1 and positive QRS in V6 and Lead I). This was confirmed in the cath lab, as the patient had an occlusion of the left anterior descending artery near the bifurcation of the circumflex. is extensive, covering the entire anterior wall, and extending into the high and low lateral walls. Interpretation: The rather obvious ST-elevation M.I. With his symptoms and this alarming ECG, he was sent promptly to the cath lab. Lead II is equally biphasic while I and aVL are positive, indicating an axis that is shifted slightly to the left. There is ST depression in the inferior leads, II, III, and aVF. There is also ST elevation in aVL with ST straightening in Lead I. The shape of the ST segments in the anterior wall range from coved upward in a “frowning” shape (V1) to very straight (V5 and V6). There is ST segment elevation in all precordial leads, except for possibly V6. The ECG: The rhythm is normal sinus at a rate of about 76 bpm with normal intervals. The Patient: An elderly man presents with chest pain, pallor, diaphoresis and weakness.
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