The Widow Maker: One ECG Pattern You Do Not Want to Miss

Aiman Smer, MBBCh, Mohamed Ayan, MD, Alok Saurav, MD

September 1, 2015

A 65-year-old man presented with chest discomfort. He is a smoker and has strong family history of premature coronary artery disease (CAD). Physical examination was remarkable for grade II/VI holosystolic murmur. ECG revealed sinus rhythm with diffuse ST-segment depression and ST-segment elevation in leads aVR and V1 (figure 1). Laboratory tests were significant for positive troponin I at 1.3 ng/ml. Echocardiogram showed severe hypokinesis of the anterior wall with estimated ejection fraction of 30-35% and moderate mitral regurgitation. 

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