A 50-year-old man is admitted to an out-of-town hospital with an acute infarct. He received a fibrinolytic drug with transient improvement. Chest pain recurred and he is transferred for further treatment.

• Sinus rhythm with marked sinus arrhythmia
• Inferior-posterior injury pattern
• Acute inferior-posterior infarct

The following ECG is recorded on the following morning, immediately before the patient is taken to the Cardiac Catheterization Lab:

• Sinus rhythm
  
• Serial changes of acute inferior-posterior infarct
  

The patient was taken to Cardiac Catheterization Lab and underwent coronary angiography. The right coronary artery was totally occluded in its proximal segment. The lesion was successfully cannulated, dilated and stented. There were only minor irregularities in the left anterior descending and circumflex arteries.