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Apparent ST depression in lead III. Is it MI?

Posted Apr 30 2011 12:20pm
A few days ago, I posted this ECG with "inferior" ST depression that was reciprocal to high lateral MI due to a 2nd diagonal occlusion.
Here is the post, with a previous baseline ECG
Here is a repost of the ECGthere is minimal but real ST depression at the J-point, in III and aVF.  Lead aVF has J-wave notching, typical of early repolarization, and should have, if anything, a bit of ST elevation (the ST segment on the baseline ECG was actually isoelectric).  The ST depression in III and aVF is reciprocal to real ST elevation of the J-point in lead aVL (and I).

The next day I saw this ECGOne might say this has the same findings, but if you look closely, the J-point in lead III is isoelectric, as is lead aVF.

I immediately saw this as a normal ECG, but realized that some would see the downsloping in lead III and think that there is ST depression, same as the former ECG.  They are different and the difference is sublte but real.

The second is normal and I sent the patient home with noncardiac chest pain.
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