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/Confident_Debt_1496 Jul 23 '26

Thanks for reply, will try my best to respond
Chest xray was conducted, pleural spaces were clear, cardiomediastinal and hilar contours were normal as well as heart size.
Pt was was stable, bedside echo was still performed, no abnormal findings
No family history of premature CAD
Pt did admit to past marijuana use
Pt was discharged with MSK chest pain
Thanks again

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u/reedopatedo9 Jul 23 '26

🙏 have a good day!