A nuanced diagnosis with grave implications: importance of a rare ECG Pattern

Abstract

A 63-year-old man with a history of hypertension, hyperlipidemia, tobacco use, and hepatitis C status-post treatment presented to the Emergency Department with a two-hour history of sudden-onset stabbing central chest pain with radiation to the back. He experienced diaphoresis and nausea during the onset of chest pain. The patient was given aspirin and experienced some relief with the third tablet of nitroglycerin. Chest X-ray showed no acute findings. An ECG was performed (Figure 1) and showed upsloping ST-segment depression at the J point in the precordial leads with progression into tall, symmetric T waves in these leads and mild ST-segment elevation in lead aVR.