A 60 year Old Man Presenting With Vague Chest Pain On Exertion..

A 60-year-old man was seen as an out-patient, complaining of rather vague central chest pain on exertion.  He had never had pain at rest.
ECG was done and is shown in picture below:

What does this ECG show and what would you do next?

The ECG shows:
• Sinus rhythm
• Normal axis
• Small Q waves in leads II, III, VF
• Biphasic T waves in leads II, V6; inverted T waves in leads III, VF
• Markedly peaked T waves in leads V1-V2



Clinical interpretation
The Q waves in the inferior leads, together with inverted T waves, point to an old inferior
myocardial infarction. While symmetrically peaked T waves in the anterior leads can be
due to hyperkalaemia, or to ischaemia, they are frequently a normal variant.

What to do
The patient seems to have had a myocardial infarction at some point in the past, and by implication his vague chest pain may be due to cardiac ischaemia. Attention must be paid to risk factors (smoking, blood pressure, plasma cholesterol), and he probably needs long-term treatment with aspirin and a statin. An exercise test will be the best way of deciding whether he has coronary disease that merits angiography.

Conclusion
Old inferior myocardial infarction.