Abstract
A 70-year-old man was seen in the emergency department for severe substernal chest pain that had become progressively worse during the past 48 hours. The initial ECG showed pathological Q waves and T-wave inversion in leads I and aVL, with only slight ST segment elevation. He was hospitalized and found to have elevated creatine kinase levels that peaked at 3,360 mU/mL. On hospital day 3, cardiac catheterization showed total occlusion of the left anterior descending artery and severe stenosis at the origin of a large ramus intermedius artery. Because of the unfavorable anatomy and presumed long interval since onset, no coronary intervention was performed.Several days later the patient complained of a new type of chest pain that involved primarily the left shoulder. A pericardial friction rub was noted, and a rapid irregular rhythm began. The ECG is shown.
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