The Patient This ECG was obtained from a 74-year-old man who had a history of COPD. He was complaining of severe chest pain at the time of the ECG.
The ECG The rhythm is atrial fib or flutter (the R to R intervals are irregular, but seem to repeat about 4 interals). Flutter waves are seen during some of the longer intervals. The rate is approximately 90 beats per minute. The ST segments are very noticeably elevated in Leads II, III, and aVF. There is reciprocal ST depression in Leads I and aVL, and also in all the precordial leads.