5 Feb

What do you think of this one?

Young male, chest pain and unwell. No syncope.




5 Responses to “An ECG”

  1. Rahul Goswami (@Rahul_Goswami_) February 6, 2013 at 04:51 #

    Interesting one.
    1. HOCM – the q-waves laterally
    2. Vasospasm if he is a IV sympathomimetic user – signs of ischaemia in avL and elevations in V2/V3

  2. Egon Zwets February 6, 2013 at 07:46 #

    I thought of HOCM because of the deep small q waves

  3. Sebastian February 6, 2013 at 09:16 #

    My thought was ischemia as well. Inverted T-waves in aVL may be an early sign of anterior MI preceding the elevations in the precordial leads. So reciprocal depressions before ST-elevation.
    HOCM is good one too!

  4. Femke February 7, 2013 at 01:56 #

    Not convinced on HOCM; Qwaves narrow, but not deep (ie <1/3 of QRS), certainly a hint of LVH, but no strain.
    Ischemia is on top of my list, with negative Ts in AVL and a start of ST depression there as well; a start of ST elevation in inferior leads (and potentially anteriorly, although that could be normal for him), and if you wanted: hyperacute Twaves maybe.
    Of note (relevant negatives): normal ST segment in aVR; and no sign of PR depression; no signs of RV strain.
    But why? Not tachy, so current amphetamine intoxication unlikely. Anatomical lesion (?spasm) likely located in RCA or LCX. Would certainly expect to start to see some more reciprocal depression. Any chance you can show us a repeat ECG?

  5. René Verbeek February 10, 2013 at 11:29 #

    History? Vital signs? Physical exam? Serial ECG’s?
    What caught my eye, besides the inferolateral Q-waves, are the left axis and clockwise rotation.
    Neg T-wave is aVL is not uncommon. High T-waves precordial is common with high QRS-voltages (more tissue depolarized -> more tissue repolirazed; or a skinny person).
    ST-elevation in V2-4 could also be BER.

    So, back to my first sentence: History? Vital signs? Physical exam? Serial ECG’s?

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