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Patient
77-year-old-man, smoker, hospitalized for episodes of chest pain followed by intermittent pain during rest for 2 days; ECG recorded during an episode of pain;
Trace
Sinus rhythm, normal PR interval; significant depression in leads V1 to V4 with negative T-waves;
Trace
ECG recorded after a coronary angiography with evidence of proximal LAD sub-occlusion and treatment with angioplasty and stent placement; moderate increase in cardiac enzymes leading to the diagnosis of NSTEMI; normalization of the ST-segment and T-wave polarity;
Patient
65-year-old man, COPD with chronic respiratory failure, hospitalized for chest pain initially occurring during exercise and then at rest; ECG recorded during an episode of pain;
Trace
Sinus rhythm, right bundle branch block pattern with left anterior fascicular block (left axis); ST-segment depression from V2 to V5;
Trace
ECG recorded after administration of 2 puffs of nitroglycerine; regression of the amplitude of the depression; the biological work-up did not show increase in cardiac enzymes leading to a diagnosis of unstable angina; coronary angiography showed a very severe stenosis of the LAD;
Exergue
In an unstable angina or a NSTEMI, the electrocardiogram can reveal a ST-segment depression with negative T-waves.
These two patients presented an acute coronary syndrome with evidence of ST-segment depression. An acute coronary syndrome occurs when an atheromatous plaque becomes unstable leading to total or partial occlusion of a coronary artery.