Scenario: This ECG (lead V1) was obtained from the bedside monitor on a 63-year-old woman in no apparent distress in the postprocedural unit. The nurse noted new ST elevation. The patient complained of chest pain and fatigue 1 day earlier but her troponin I levels did not indicate infarction. Her history includes obesity, hypertension, smoking, and prior myocardial infarction (MI) with stent placement 1 year ago. Based on her history and symptoms, an angiogram was performed that revealed no significant occlusions, including at the stent location, and all other cardiac structures were normal. The patient was resting comfortably and had no symptoms.

Sinus bradycardia at 55/min, first degree atrioventricular block (AVB), possible prior septal infarct and ST elevation consider ischemia. Note the x2 (arrow on figure above) next to the label Trace 2 (V1). This indicates the gain of...

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