Category: Dr. Smith’s ECG Blog

ST elevation in aVL with reciprocal ST depression in the inferior leads

Written by Pendell Meyers A male in his 50s with history of thyroid cancer was brought to the Emergency Department after being found minimally unresponsive with sonorous respirations on his couch at home. Blood glucose level was 76 mg/dL. EMS administered naloxone, which was followed quickly by hyperventilation but no improvement in mental status. EMS

“This is not a Subtle ECG, right?”

A reader texted this ECG without any clinical information, with the question: “This is not a Subtle ECG, right?” My response:“No!  Activate!” The reader reported that this ECG was not recognized as abnormal and that he himself had found it at the doctor’s station shortly after it was recorded.  The reader was concerned about the

Are These Wellens’ Waves??

This is a repost.  I’ve received a few questions like this, so wanted to re-inforce the idea of down-up vs. up-down T-wavesCase:One of our residents texted me this ECG and was worried about Wellens’ waves.A middle-aged male presented with vomiting.  Here was the initial ED ECG: What do you think? Here is my response:  “What

A 70-something woman with syncope and a wide complex

This case was written by Andy Lichtenheld (, a really smart 2nd year resident here at our Emergency Medicine program at Hennepin County Medical Center.  Here is some shameless promotion of our residency, which was started in 1972 and which we think is second to none: Learn why our current PGY1s chose Hennepin. (PDF) Learn why our current

A 30-something woman with chest pain and h/o pulmonary hypertension due to chronic pulmonary emboli

A 30-something woman with known history of pulmonary hypertension due to chronic pulmonary emboli presented with 12 hours of substernal chest pain. Here was her ED ECG: What do you think? This precordial T-wave inversion is typical of right ventricular hypertrophy (RVH).  However, most other features of RVH are not present.  There is an incomplete