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Patient
65-year-old man, non-insulin-dependent diabetic, hypertensive, hospitalized for chest pain of increasing intensity, initially occurring during exercise, and then at rest since 2 days; increased troponin;
Trace
This electrocardiogram shows sinus rhythm of 95 bpm, with an ST-segment elevation of 3 mm in aVR, 2 mm in V1 and a diffuse and relatively large ST-segment depression (inferior leads, V3-V6);
Trace
Emergency coronary angioplasty identified a severe sub-occlusive stenosis of the left main coronary artery; an angioplasty with stent placement was successfully performed; the electrocardiogram upon the return to the ward showed a normalization of the ST-segment;
Exergue
The presence of a ST-segment elevation in aVR during chest pain is a sign of severe and proximal disease, is a factor of poor prognosis and should warrant an emergency revascularization procedure.
The electrocardiographic aspect of this patient was highly evocative of an occlusive or sub-occlusive disease of the left main coronary artery which was confirmed by coronary angiography.