Small Ts in 1 and V6

Re-arrange ECGs to true time sequence, re-write report!

Report:

Sinus rhythm 59/min

T wave changes c/w ischæmia

Comment:

The TV1 > TV646 or T3 > T1 phenomenon is less well known than it should be. It is not normal, as most computer programmes would have it. The first set of cardiac injury markers was normal and the patient was lucky not to have been sent home. An (almost) normal trace belonging to this very patient prior to his current predicament is shown below (Fig 62a). At least the T waves were normal then; the anteroseptal ST segments tell a different story, soon to become more explicit. Wisely, he was admitted to CCU anyway, on account of typical pain.

What, unsurprisingly, happened two days later, is shown next (Fig 62b). This time the computer calls the acute anterolateral infarction “nonspecific lateral T wave changes”. It may be taking my own strategy of under-reporting too far.

He had CABGs 6 months later.

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