Electrocardiographic manifestions of proximal left anterior descending artery occlusion

A Case of Nonischemic T-Wave Inversions

“…Importantly, these patterns include isoelectric or minimally elevated ST segments, absence of precordial Q waves, a history of anginal chest pain with the ECG being obtained during a chest pain-free interval, and normal cardiac enzyme levels. [3][4][5] While this ECG raises concern for a type 1 Wellens pattern, a closer inspection of the ECG reveals (1) tall R waves in the right precordial leads in concert with deep S waves in the lateral precordial leads; (2) an R wave to S wave amplitude ratio greater than 1 in lead V1; (3) right atrial enlargement suggested by the P wave taller than 2.5 mm in leads II and III and aVF (historically known p pulmonale, …”