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Patient
74-year-old woman, obese, hospitalized for repeated episodes of chest pain since the past several days; ECG recorded during chest pain following exertion;
Trace
Sinus rhythm, normal PR interval; presence of a relatively wide Q-wave in lead III and QS pattern in aVF; isoelectric ST-segment; negative T-waves in the inferior territory from V4 to V6 (posterolateral subepicardial ischemia); peaked and symmetrical T-waves of "ischemic" appearance in V4-V5;
Trace
ECG performed just after administration of 2 nitroglycerine puffs; resolution of pain and normalization of T-waves (positive in leads II, aVF, V4-V6);
Exergue
Ischemic T-waves can be positive (symmetrical and peaked, subendocardial ischemia), negative (symmetrical and peaked, subepicardial ischemia), flattened, biphasic (particular pattern of Wellens' syndrome) or normalized (negative T-waves temporarily positive).
The coronary angiography performed in this patient showed the presence of a severe stenosis of the right coronary artery.