- HPI: 50F with severe substernal chest pain x 30 min
- Cath: complete occlusion of the proximal LAD which was opened and revealed a very large first diagonal (this explains the predominance of V4-V6 on the ECG)
- Key ECG: There are hyperacute T-waves in V4-V6, I and aVL, with reciprocal ST depression and T-wave in version in III and aVF. V4 shows a de Winter’s T-wave, with some ST depression. This is suggestive of proximal LAD occlusion
- Link to full case @ Dr. Smith’s ECG Blog: 2014-08-09