This ECG was obtained from a man in his 70’s. We have no other clinical information. It is interesting for several reasons.
T Wave Inversion
This ECG is from a 54-year-old woman who had an M.I. one week prior to this tracing. She did not receive interventional treatment, as it was not available where she lived when this happened years ago. Her ECG shows the signs of healing injury, as well as probable permanent damage.
This ECG is from a 50-year-old man with chest pain. Unfortunately, we don’t have any other clinical information. This tracing is a good example of widespread, symmetrical inverted T waves. Inverted T waves are present in Leads I, aVL, II, and V3 through V6. (The anterior-lateral leads). There are ST segment elevations in Leads V1 and V2.
This ECG was obtained from a 49-year-old man who was a patient in an Emergency Dept. We do not know his presenting complaint, only that he had a history of insulin-dependent diabetes mellitus (IDDM). It was noted by the donor of the ECG that the patient had no chest pain, no shortness of breath, and no other cardiac symptoms. We do not know his hydration or electrolyte status. There are quite a few interesting abnormalities on this ECG, and the exact interpretation would, of course, depend upon the patient's clinical status.
This is a very interesting ECG taken from an acute M.I. patient. Your basic level students will be able to appreciate the ST elevation in V1 through V3. Although the elevations are not very high, there are plenty of other abnormalities that point to acute STEMI: the ST segments are flat and there are marked ischemic T waves in the lateral leads: V4 through V6 and I and aVL. The patient was suffering an acute episode of chest pain.
This ECG is the last in a series of 6 that were donated by Jenda Enis Štros showing the evolutionary changes of an M.I. from onset, through spontaneous reperfusion, angioplasty, re-occlusion by thrombus, and recovery. This ECG shows deep precordial T wave inversions, an expected evolutionary change after reperfusion of an occluded artery - in this case, the left anterior descending. The patient has lost some of his QRS amplitude (viable heart muscle), but has not developed pathological Q waves.
Continuing our teaching series of ECGs donated by Jenda Enis Štros, ECG 4 of 6 shows a new occurance of huge T wave inversions in the precordial leads. Since this is the area that was stented (left anterior descending artery, anterior wall of the LV), we immediately should think of re-occlusion of the artery. In a newly-placed stent, the danger is thrombosis (blood clot). The patient had no chest pain at this time.
Here are links to all six of the ECGs in this series:
During our summer break, we are reprising a few of the best ECGs from our archives, to give you a chance to comment or to ask questions.
This ECG was taken from a 52 year old man who was complaining of chest pain, with a history of severe multi-vessel disease. He has a history of M.I. and states he has five coronary stents.
This ECG was taken from a 49 year old man with insulin-dependent diabetes, with no complaints of cardiac symptoms. The rest of this patient's history is lost. This is a great ECG for demonstrating the flat ST segments and T wave inversion of ischemia due to coronary artery disease. The ECG changes are very noticeable in the lateral wall. It is not known why the patient presented with sinus tachycardia.
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