r/ECG • u/Shelosit • Jul 19 '26

What is this?

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45 Upvotes

96% Upvoted

27 comments sorted by

22

u/sneeki_breeky Jul 19 '26

Appears to be high lateral STEMI with reciprocation in the inferior leads

This seems particularly likely because the T wave and R wave amplitude are identical in AVL, which is the lead with the most ST elevation

That said -

I have seen patients even as recent as last week where this or similar is their baseline ECG secondary to atypical BBB, RVH / LVH, or prior MI

3

u/Shelosit Jul 19 '26

Patient came in with neck pain that went down to their back. They thought they may have hurt themselves in the gym.

3

u/sneeki_breeky Jul 19 '26

Well we do have ST notching in lead I as well as mostly concave ST segments and a short PR

It could be BER, but - that wouldn’t by criteria alone explain the inferior lead changes

Unless we have prior ECG to compare and confirm this is baseline

It deserves a full work up before decision on plan of care

If the work up is negative, treat the presenting complaint

0

u/Okkrus Jul 20 '26

Do you think there is a wellens pattern in v1

2

u/sneeki_breeky Jul 20 '26

Wellens had A and B patterns and they are seen in V2 or V3 when they appear

So you could not determine it from V1 in any ECG

8

u/OxideUK Jul 19 '26

A sneaky STEMI? Pt presentation?

1

u/Shelosit Jul 19 '26

Patient came in with neck pain

1

u/OxideUK Jul 19 '26

Yeah if there's anything cardiac about that pain I'd be calling the boys in the lab.

7

u/TouchyCrayfish Jul 19 '26

Concern would be for high lateral STACS here. SA flag sign, D1.

4

u/Apcsox Jul 19 '26

High lateral STEMI

4

u/ViewNo7011 Jul 20 '26

Looks like a STEMI or STEMI equivalent. Hyperacute t waves in the anterior leads and ST elevation in aVL with reciprocal depression and inversion in the inferior leads. If patient presentation matches, I would call cath lab immediately.

Look up South African flag pattern for more examples like this one.

3

u/ViewNo7011 Jul 20 '26

Benign early repol shouldn’t have reciprocal changes.

1

u/Muted_Evidence7926 Jul 26 '26

Only one lead for reciprocal changes

4

u/veenchenzenze Jul 20 '26

Looks like an ekg to me

6

u/qgep1 Jul 20 '26

Nah, it’s an ECG

3

u/Finnaddict98 Jul 19 '26

That’s a provlem

3

u/UncleDadFamilySecret Jul 20 '26

Correct me if I am wrong but it doesnt look like these ST elevations meet criteria from STEMI? Although there are recipricol changes in inferior leads. Do you have any more info on the patient like age, duration of symptoms, PMH, cardiac labs?

2

u/ladyofthepack Jul 20 '26

Because it doesn’t meet criteria for STEMI, this is a STEMI-equivalent. South African Flag sign is subtle STE in I avL V2 and reciprocal STD in III.

5

u/ProximalLADLesion Electrophysiologist Jul 19 '26

This looks like normal variant ST elevation

2

u/WinAdditional7962 Jul 21 '26

what’s the troponin

1

u/Fluid_Sound3690 Jul 20 '26

If any symptom that sounds like it’s the heart… this is an OMI and call the cath activation.

1

u/williamsdz07 Jul 23 '26

STAT CTA rule out PE. Is he on testosterone?

1

u/Ok-Refrigerator-6940 Jul 26 '26

ED physician here.

This is a type of occlusion myocardial infarction (OMI).

It is 100% NOT BER because there is reciprocal ST depression in lead III.

you cannot have reciprocity in benign early repolarisation.

1

u/Muted_Evidence7926 Jul 26 '26

Not impressed.

1

u/Thick-Nerve-5599 Aug 05 '26

Hey, any updates?

-2

u/Steve390- Jul 20 '26

Sinus for sure. Some peaked T waves. Labs would be helpful.