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Image challenge
Typical chest pain and an ominous ECG
  1. Rahul Kumar,
  2. Dinkar Bhasin,
  3. Hermohander Singh Isser
  1. Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
  1. Correspondence to Professor Hermohander Singh Isser, Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India; drhsisser{at}gmail.com

https://doi.org/10.1136/heartjnl-2020-318570

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    Clinical introduction

    A middle-aged man in his 50s presented to our emergency department with retrosternal chest discomfort of 2-hour duration. His cardiovascular risk factors included smoking and hypertension. The patient had no history of similar episodes. On examination, his heart rate was 72 beats per minute, and his blood pressure was 114/74 mm Hg. The rest of the physical examination was unremarkable. The ECG at presentation is shown in figure 1. A qualitative troponin assay at the time of presentation was negative.

    Figure 1

    Twelve-lead ECG at presentation.

    Question

    1. Which of the following coronary artery lesions is responsible for this specific ECG pattern ?

      1. Proximal site of left anterior descending artery.

      2. Proximal site of …

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    Footnotes

    • RK and DB are joint first authors.

    • RK and DB contributed equally.

    • Contributors RK and DB contributed equally to this paper and are joint first authors.

      All authors contributed to design, data collection, preparation and review of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.