Ischæmic ST Segment Depression

Report:

Sinus rhythm 88/min

ST/T changes suggestive of ischæmia

Comment:

In a person with chest pain (or equivalent – women have a lot of those55) this ECG is diagnostic. There are plane, slowly rising, or downsloping ST segments in many leads and elevation in aVR, complemented by several sharp ST/T angles. Better still, rapid resolution in response to treatment by nitroglycerin confirms the diagnosis. We all like, like the Hobbits, to confirm what we know already56.

The tracing in Fig 77a was (mistakenly) reported as normal by the computer and signed by a Cardiologist (regrettably, myself). It’s not normal: several leads still show 1 mm ST segment depression (using, properly, T-P segment as baseline). The resolution was there, but incompletely so. Routine reporting is like that.

77a. Not normal enough. 78. 43 year old lady transferred from a peripheral hospital with thrombolysis on the way.

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