ECG Case: Looking Closely

Here’s a busy ECG… What do you think is going on?

At first glance, this ECG is very busy! It’s important to look at the ECG as a whole but also each individual beat to make sure nothing is missed. 

First, this is a 12 lead ECG. There is no rhythm strip. 

Second, there are both normally conducted beats as well as premature ventricular complexes (PVC’s). 

Let’s identify the PVC’s (arrows)... 

When looking at ST changes, it’s important to focus on the normally conducted beats. Looking at the non-PVC beats, it’s now clear there is ST elevation in the inferior leads (II/III/aVF – black circles) with ST depression in I/aVL and precordial leads (blue circles)

Key takeaways:

• Look at each ECG closely, both as a whole as well as each individual beats 

• ST segment changes should be determined based on the normally conducted beats, not PVC’s