A 70-year-old woman with known heart murmur for over 10 years, is lately complaining of central anterior chest pain and dyspnea on exertion:

• Sinus rhythm
• Left atrial enlargement
• Left ventricular hypertrophy with repolarization abnormality

This lady was proven to have severe calcific aortic stenosis. Her coronary arteries were normal. The ST elevation in leads III and V1-V3 is reciprocal to the “strain pattern” ST depression of left ventricular hypertrophy in the left leads. This reciprocal ST elevation is not uncommon in patients with marked ECG changes of LVH and occasionally may cause concern of possible anterior wall injury pattern, if the patient presents with chest disconfort. It may be prudent for such patients to carry a copy of their ECG, particularly if they travel away from  their home area.