ECG - advanced - chest pain - 1 

Myocardial ischaemia - angina

Myocardial ischaemia typically produces displacement of the ST segment - usually depression.

Other changes may include T wave inversion, and increase in QRS amplitude.

If ischaemia is very severe and blood flow greatly impaired, cell death in inevitable,leading to infarction.

Tall, peaked or tented T waves indicate myocardial injury or hyperkalemia. Inverted T waves, particularly in leads I,II, or v3-6 represent myocardial ischaemia.    

Widespread anteroseptal ST depression

This dramatic ECG shows widespread ST depression over the chest leads.
This starts in the anterior lead V2, and continues through the septal leads (leads looking at the interventricular septum) V3-4, into the lateral leads V5-6.    


Mild antero-lateral ST depression


This ECG shows more subtle lateral ST depression which occurred at rest and did not resolve with nitrates, indicating unstable angina.