Expert ECG Quiz 9 Answer

1. Normal sinus rhythm
2. ST changes consistent with ischemia - specifically, occlusion of the left main coronary artery

This ECG shows dramatic ST depression that is downsloping consistent with ischemia. The changes are quite pronounced. One classic teaching helps to diagnose a left main coronary artery occlusion. This is ST segment elevation in lead aVR greater than the ST elevation in lead V1 along with ST depression in the precordial leads. 

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