Another tough discriminating ECG for the Fellowship exam. The ACE THE ACEM BOOTCAMP covered atrial infarctions in the ED with the Lew Criteria as key to diagnosis:
PTa elevation > 0.5 mm in II, III OR AVF ( right side) or V4,5 ( left atrial)
With reciprocal PTa depression in precordial leads.
Also note the increased mortality associated with atrial rupture !!!