A 43-year-old man was admitted to the hospital with severe chest pain lasting one hour.
The ECG showed mild lower E-ST, prominent J wave in V1-V2 and D-ST marked in leads V1 to V5.
Diagnosed inferential-posterior AMI, the patient received thrombolytic treatment with reteplase.
An hour later the ECG showed an incomplete RBBB, a J wave (R') manifests in V1-V2 leads and absence of ST segment deviations.
There were also high R waves affecting the initial part of the QRS complex and T waves in leads V2-V3, which would suggest the diagnosis of further AMI.
Eight hours after admission, ECG showed an inversion of T wave in leads III and aVF, a J wave in V1-V2 and a concave E-ST leads with positive T wave in V4.
Three days after the ECG, a J-wave, a concave STE, and a positive T-wave from V2 to V5 suggested PES.
Creatine kinase increased to 4.999 U/l (with a MB fraction of 254).
An echocardiogram revealed inferomental and apical akinesia.
A coronary arteriography showed a 90% stenosis in the middle third of the right coronary artery, and 60% in the proximal portion of the circumflex artery.
After stent placement in the right coronary artery, the patient has been asymptomatic for three years.
