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Patient
81-year-old man with no specific history, followed for moderate hypertension;
Trace
This tracing was recorded during a consultation in an asymptomatic patient; left anterior fascicular block with no significant abnormality of the ST-segment or T-wave;
Three months after this consultation, appearance of typical chest pain; recording of a tracing at his cardiologist's office in the absence of pain;
Trace
Relative to the previous tracing, modification of the electrocardiogram with signs of subendocardial ischemia (significant increase in T-wave amplitude in V2-V4, symmetrical and peaked T-waves); ST-segment remaining more or less isoelectric;
Exergue
The subendocardial ischemia pattern (positive, tall, symmetrical and pointed T-waves) may diminish (spontaneously or after administration of nitroglycerine puffs) in the presence of stenosis of a coronary artery or, conversely, evolve toward a Pardee wave pattern with elevation in the presence of a coronary occlusion.
The second tracing of this patient is suggestive of an anterior endocardial ischemia and severe LAD stenosis was demonstrated at coronary angiography.