LAUSR

A previously healthy 58-year-old male hospital staff member presented to the emergency department (ED) with chest pain, which had started several minutes ago. He was haemodynamically stable with no clinical evidence of heart failure. The first electrocardiogram (ECG) taken 6 min after arrival showed ST-segment elevation in leads I, aVL and V2–6, with ST depression and T wave inversion in lead III, suggestive of an acute anterolateral myocardial infarction (MI) (Fig. 1a). He was treated with aspirin, ticagrelor, nitroglycerin sprays, intravenous morphine and metoclopramide in the ED with relief of chest pain. The initial high-sensitivity cardiac troponin-T level was not elevated. The second ECG taken 28 min after arrival revealed upsloping ST-segment depression > 1 mm at the J point and tall, symmetrical T wave in leads V1–V4, which was compatible with the de Winter ECG pattern (Fig. 1b). The patient underwent transradial coronary arteriography 55 min after the second ECG, which showed total occlusion of the mid left anterior descending artery (LAD) with thrombolysis in myocardial infarction grade 0 coronary flow and no collateral filling (Rentrop class 0) (Fig. 1c). Thrombectomy, followed by insertion of a drug-eluting stent, was performed uneventfully (Fig. 1d). Discussion