A 71 year-old man was awakened with severe chest pain.  He called paramedics who treated him with ASA and brought him to the ER.  Upon arrival, he was pain free.

• Sinus rhythm, rate 74/min
• Non-specific ST changes (less than 1mm ST elevation in lead V1 and ST depression in inferior leads)

While in the emergency room, he experiences a recurrence of severe chest pain and a repeat ECG is performed.

• Sinus rhythm, rate 90/min
• Acute anterolateral infarction (ST elevation V1 to V5 and I/AVL with inferior ST depression
• Premature ventricular complex

The patient was taken urgent to the cardiac catheterization laboratory and found to have an occlusion of the LAD.  He underwent successful PCI and stenting.  The ECG below was taken 6 hours after original presentation

• Sinus bradycardia, rate 52/min
• Septal myocardial infarction (Q-waves leads V1/V2)