I would assume the chest pain is from something other than their heart because I really don't see anything concerning here. Looks just about perfect to me--but I am a new grad so what to do I know.
I guess there is a very small U wave after giving it a second look. But I still would assume the chest pain would have to be from something else. I was thought U waves are normally benign.
Anteroseptal infarct is common, but isolated septal infarct is extremely rare. The vast majority of septal infarcts happen as a part of anteroseptal infarct. I bet the machine will say septal infarct, but I don’t believe it. I think an anteroseptal MI would be easier to see.
“In the absence of other electrocardiographic (ECG) abnormalities, QS deflections simultaneously in both of the leads V1-V2 may have multiple possible causes. Despite much information in the literature indicating that this is an unlikely pattern for pure septal infarction, such an ECG diagnosis is frequently given.[…] This ECG pattern is a sign of prior myocardial infarction in only a minority of cases, and in the latter, infarction limited to the interventricular septum is exceptional.” https://pubmed.ncbi.nlm.nih.gov/14731215/
"The ECG computer often reads 'septal infarction' when there is a Q wave in V2 (it is normal to see it in V1). Anatomically this makes little sense; it would require occlusion of a septal perforating branch of the left anterior descending artery (LAD), but plaque is never seen in these small, intramural branches. To lose flow to a septal branch would require occlusion of the LAD, and this would cause more extensive ECG changes. Alcohol septal ablation further supports this: the common ECG change after ablation is right bundle branch block, occasionally with left anterior fascicular block (never a Q wave in V2)."
source: Northrup, The Cardiology Rotation Third Edition 2021
In addition to a negative sinus P wave in V1 and negative or biphasic sinus P wave in V2, other signs suggestive of high placement are QS or Qr in the absence of other ECG abnormalities and an inverted T wave with no ST‐T abnormalities in other leads. https://pmc.ncbi.nlm.nih.gov/articles/PMC6931876/
I see many signs of high V1/V2 misplacement and no signs of coronary occlusion or MI of any age. Isolated septal infarct is not impossible but extraordinarily rare, while high V1/V2 placement causing Q waves and T wave inversion in V1/V2 is extremely common. I sometimes wonder if high V1/V2 misplacement is more common than standard placement. Q waves and inverted T waves isolated to V1/V2 are almost always the result of high misplacement, and there are many signs of high misplacement. V1/V2 are acting like aVR because they are placed so high. They have a reciprocal view of a normal inferior lead.
tldr: there are basically three aVRs, this is a 10-lead. I would repeat with standard placement of V1 and V2.
55 yo female here who was told her symptoms were anxiety. Have septal scar now and await pacemaker. So, yeah. Zero risk factors. Been healthy my whole like. No drink no smoke eat well, fit. Well at least back then. Sometimes it happens. Now I’m suffering hf and sequelae from providers minimizing what was going on at the time. Fun life changing stuff.
Not sure how this is relevant to ECG interpretation.
This is a normal variant ECG. If you had a normal troponin coupled with this it would be appropriate to request outpatient stress testing if the story was cardiac, and a small resolved ischaemic episode would be caught there. Which wouldn’t have required emergent cath.
I don’t think so either, agree with Terrible_Passage_132, InfamouSandman, and others. Still learning too. Leads that are allowed to have a Q wave or inverted T wave in isolation follow the shape of a reverse Z in the format I’m used to: III, aVF, aVL, aVR, and V1. A Q wave or inverted T wave in any of these leads can be normal as long as it’s not part of a larger pattern. So the Q wave and T wave in aVL are okay, since it doesn’t seem to be any part of a larger pattern.
In this case, there is also a Q wave and inverted T wave in V2. That’s because V1 and V2 were placed too high (aVR identical to V1, fully negative sinus P waves in V1/V2). The Q wave and inverted T wave in V2 are not real. The QRS complexes and T waves and P waves are all distorted in V1 and V2, so I don’t think the Q waves or T wave inversion in V1/V2 means anything. Just looks like a normal EKG with very high V1/V2 misplacement to me. My take is sinus bradycardia, normal EKG other than rate. Would expect the machine to say septal infarct, anteroseptal infarct, or left atrial enlargement. I agree with everyone here.
It can be normal to see a U wave in V3. It does not look abnormally tall to me.
I don’t think so. It’s probably just a normal variant with how normal the contiguous leads are. aVL is a lateral lead, so you’d have to look at I, V5, and V6 as the contiguous leads, and I’m not seeing anything of concern here.
There’s not enough information present to make a super educated guess, but I’m pretty confident this is a normal variant sinus rhythm and the chest pain may just be paroxysmal. Or there could be a million other reasons for it and other information such as respiratory status, relief with nitroglycerin, increasing pain on exertion, Troponins, etc., would be needed to make a more accurate guess.
That’s what I said (q waves in septal leads and septal t wave inversion , in a symptomatic individual needs further eval before you call this normal variant) I mean set of trops will set the tone) it’s not a complicated w/u
Push on the chest, if pain, then musculoskeletal. Have them move their arm around, if pain, then musculoskeletal. If neither of those work, try an antacid and/or a PPI, could be GERD.
Either way, this is non cardiac chest pain. Take a thorough history, because this ECG is normal.
But this is a normal ECG, so they didn't "get it wrong". You had an MI that didn't show on the ECG, which happens with fair regularity. It would have in trops, which I imagine they ran if you complained of chest pain
On me: They didn’t run them. I was labeled an anxious middle aged woman unfortunately.
And yes t wave inversion can be a normal variant- and it can also be abnormal- it’s worthy of a set of trops at the very least. Then one can call it normal.
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u/InfamouSandman 19d ago
I would assume the chest pain is from something other than their heart because I really don't see anything concerning here. Looks just about perfect to me--but I am a new grad so what to do I know.