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Kudos to the intern once again, Dr Anver Sethwala (2nd time contributor to AM ecg case of the week, he's an astute member of Aequa also).. As said many times, everyone can acquire good ecg skills, is just a matter of attitude and time..PE’s often produce ECG changes tat mimic cardiac ischemia & frequently elevate troponins. (sepsis,CHF,HTN, etc..) BNP may b elevated also from right heart strain other than CHF.Simultaneous TWI’s in anteroseptal & inferior leads = PE until proven otherwise. (don just rely on S1Q3T3, sinus tach, and other classic ecg signs of PE)