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All ECG 41

  1. Normal sinus rhythm
  2. ST changes consistent with ischemia - specifically, occlusion of the left main coronary artery

This ECG shows dramatic ST depression that is downsloping consistent with ischemia. The changes are quite pronounced. One classic teaching helps to diagnose a left main coronary artery occlusion. This is ST segment elevation in lead aVR greater than the ST elevation in lead V1 along with ST depression in the precordial leads. 

Related Topic Reviews: Anterior MI ECG Review, Determining Axis