So what can I do to help me. Crystal ball you say?
AVL…..the crystal ball of EKG.
Mattu would refer to it as the Dangerfield lead…cant get no respect. Dr Henry J. Marriott identified this correlation 40 years ago but has seemingly escaped being included in our collectively perpetuating repertoire as pre hospital magicians.
More importantly than seeing into the future, is what you can see in the future. Prediction of evolving MI you say…whoa. Tell me more
Just say you went in an tied off the right coronary artery, for fun (type III fun), what would change first…thats right…AVL;
T wave inversion would occur.
Deviance from an almost-to flat T wave into a easily discernible flipped/inverted belly like T wave in AVL. You might even see some ST depression.
But what about LBBB… means nothing. Strain pattern? =both changes in AVL and Lead I. Horizontal heart…dont matter
OK, enough from us. Whet your appetite? Hope so. Ill let Master Mattu take it from here.
In summary, experiencing chest pain….atypical findings, no baseline ECG to compare…no significant ischemic changes on 12 lead investigation….look to AVL…look to the future…advocate for those people you serve, repeat the ECG, consider the appropriate cath capable facility and at the very least have the discussion with your ERP.
Thanks for reading. Go well. AVL.