The story is so important to get early. Why? Because it primes us for how to look at the ECG.
Always ask, “What has the patient presented with?”
If the answer is chest pain, then we can zero in on looking at ischaemic changes in the appropriate arterial territories, i.e.., inferior, anterior and lateral. We’ll look for ST elevation or depression and reciprocal changes.
If the answer is palpitations, then we look at the rhythm strip, lead II and pay attention to the rate, as it’s the tachycardias that result in palpitations. We can look for changes that may be consistent with arrhythmias i.e., Brugada, Wolff-Parkinson-White, epsilon waves etc.
It is possible to get ischaemia, leading to ventricular tachycardia and palpitations.