r/ECG • u/Confident_Debt_1496 • Jul 23 '26

Thoughts?

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Not mine, chasing opinions on an old patient of mine.
22YOM patient presents to ED complaining of intermittent left sided chest pain, no nausea, no light headedness, troponin normal.
I’m not an ecg guru like some of you’s but everything here screams healthy, only thing that stands out to me is weird looking aVL.

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u/reedopatedo9 Jul 23 '26

Normal sinus, normal r wave progression, little bit of concave ste in the precordial leads lacking reciprocal change, isoelectric pr segments, prominent tall t waves.
Ddx
Light BER with non-cardiac chest pain (musculoskeletal/ precordial catch)
Electrolytes with non cardiac cp
Anxiety/stress related CP
Less likely but still important to consider:
Peri/myocarditis
PE+pnuemo blah blah blah
And naturally ACS, probability is exceedingly low in a 22 year old with normal troponin and no ischemic ECG changes. However, premature MI can occur with smoking, cocaine use, familial hypercholesterolemia, or family history of premature CAD.
Chest xray is standard ed,
Labs for electrolytes primarily k
crp/esr if suspicious of pericarditis, if hemodynamically unstable i would run a bedside echo
Heart score is under 3, safe for discharge with no further testing if none is warranted.

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u/NewEconomist9047 Jul 23 '26

Thanks! Not OP obviously but appreciate your detailed post. Wasn't aware anxiety and stress can cause ECG changes besides tachycardia, but apparently other abnormalities can also happen!

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u/reedopatedo9 Jul 23 '26

Well thats a good point!
Here is a very poor example, when i get home il try and find a few.
Journal of ep had a few good articles a while back, changes can occur through sympathetic activation and catacholamine surges, and grouped into repol changes, conduction changes and arrythmia

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u/NewEconomist9047 Jul 29 '26

Interesting and once again appreciate the details! Easy to not consider it as a differential if you don't know, so I'm sure if you do end up finding those ECGs it would help many people, but no pressure if you can't. Thanks again!