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Patient
47-year-old man with no medical history, hospitalized for episodes of repeated chest pain since several days; ECG recorded in absence of pain;
Trace
At hospital entry, the electrocardiogram, recorded in the absence of pain, is within the normal limits (sinus rhythm, absence of conduction disorder, isoelectric ST-segment and T-waves without abnormality);
During hospitalization, the patient developed typical chest pain with recording of this electrocardiogram after 1 hour (the patient took a long time to report the pain to the nurse);
Trace
Compared to the previous tracing, modification of the electrocardiogram with signs of subendocardial ischemia (significant increase in T-wave amplitude in V3-V5, peaked and symmetrical T-waves); ST-segment remaining more or less isoelectric;
Trace
No particular treatment was proposed; ECG recorded 2 hours after onset of pain; emergence of elevation in the leads previously exhibiting subendocardial ischemia with persistence of a tall T-wave; reciprocity (depression) in the inferior leads;
Trace
The coronary angiography revealed an occlusion of the LAD with angioplasty and stent placement; electrocardiogram performed on D3 with inversion of T-waves in the same territory;
Exergue
The highlighting of tall, symmetrical and peaked T-waves in the aftermath of a very recent chest pain should evoke the presence of a coronary occlusion and therefore warrant performing an emergency reperfusion.
In this patient, the first electrical sign of coronary occlusion is the presence of subendocardial ischemia with a marked increase in the amplitude of the T-waves which become symmetrical and peaked in the absence of changes in the pattern of the QRS-complex or the ST-segment which remains isoele