As a new grad, I remember having a 38 year old male patient who came in for chest “discomfort" x 1 day.
Right away my mind started racing with every differential I knew: ACS, angina, cocaine, pulmonary embolism, anxiety, GERD, and the list went on and on…
But, I knew one thing for sure...
Regardless of the differential, I should probably get an EKG. So, that’s exactly what I did.
As I “methodically” read the EKG, I stumbled upon a Q wave in lead III.
Oh, no I thought…this guy had a heart attack!
I went back in the room and started to focus my questions to make the diagnosis of a myocardial infarction fit. It's important to know that tunnel vision can get you in trouble. You don't want to ask leading questions, just to make your differential correct (live and learn).
After my conversation, like the smart clinician I was (not), I told him I thought he had a heart attack.
Needless to say, he freaked out.
I left the room to call my boss to ask him what I should do next. The first thing he said was, "take a deep breath".
The second thing he asked me was, “how does he look? Does he look sick?”
Actually, no. He seemed fine and was joking with the MA.
In fact, the entire bases for thinking the patient had an MI was an isolated q wave in lead III.
I didn't see any ST elevation, ST depression, or T wave inversion.
As I came to learn, q waves don’t always signify infarction or even pathology.
Unfortunately, this is something I had to learn the hard way. I made many mistakes early on, when it came to reading the EKG and managing my patients.