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The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aorticvalve. Aortic angiogram did not reveal aortic dissection. If you see this, you should Doppler the valve. In the cath lab, the patient’s blood pressure remained low.
And superimposed subendocardial ischemia pattern, of course. It simply does not make physiologic sense to suddenly see an all-negative QRS complex in this most lateral chest lead. Several minutes later there was a change in the monitor, and she reported increased palpitations: With the context, this is almost certainly 1:1 flutter.
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