case_images: PMC7391081_01
case_images: 12-lead electrocardiogram (ECG) obtained at the time of arrival of the patient to the ED. ECG shows diffuse T wave inversions (blue arrows) and ST depressions in V3, V4, V5, and V6 (red arrows).
case_images: CRIONM2020-4151474.001.jpg
case_images: PMC7391081_01_CRIONM2020-4151474.001.jpg
case_images: fig1
case_images: On initial ECG in the ED, the patient was found to have ischemic changes with diffuse T wave inversions and ST depressions in V3, V4, V5, and V6 (Figure 1), and the cardiac troponin I (cTnI) was elevated to 0.06 ng/ml (reference range 0-0.03 ng/ml).
case_images: Patient's ECG three days before starting chemotherapy. ECG is normal with no ST segment or T wave abnormalities.
case_images: CRIONM2020-4151474.002.jpg
case_images: PMC7391081_01_CRIONM2020-4151474.002.jpg
case_images: fig2
case_images: Of note, patient had ECG done during his regular visit to primary care physician three days before starting chemotherapy which was completely normal (Figure 2).
case_images: Patient's ECG after 2 hours from arrival to the ED. ECG shows new ST elevations on lead 1, V3, V4, and V5 (red arrows).
case_images: CRIONM2020-4151474.003.jpg
case_images: PMC7391081_01_CRIONM2020-4151474.003.jpg
case_images: fig3
case_images: Two hours later after arrival to the ED, ECG showed new ST elevations on lead 1, V3, V4, and V5 (Figure 3).
case_images: Pictures of emergent coronary angiogram after patient's arrival to the ED. Pictures show only mild focal left anterior descending artery disease.
case_images: CRIONM2020-4151474.004.jpg
case_images: PMC7391081_01_CRIONM2020-4151474.004.jpg
case_images: fig4
case_images: The patient was taken for an emergent coronary angiogram which revealed mild to moderate proximal left anterior descending artery disease with no acute occlusion (Figure 4).
case_images: Patient's ECG after 6 hours of hospitalization. ECG shows that T waves are normalized in most of the leads, but it still remains inverted in lead II, III, aVF (blue arrows).
case_images: CRIONM2020-4151474.005.jpg
case_images: PMC7391081_01_CRIONM2020-4151474.005.jpg
case_images: fig5
case_images: T wave abnormalities (Figures 5 and 6), troponin started to trend down and chest pain resolved in 24 hours. Two days later, the patient was discharged with normal ECG (Figure 7).
case_images: Patient's ECG after 24 hours of hospitalization. CG shows that T waves are normalized in most of the leads and there are no ST segment abnormalities.
case_images: CRIONM2020-4151474.006.jpg
case_images: PMC7391081_01_CRIONM2020-4151474.006.jpg
case_images: fig6
case_images: T wave abnormalities (Figures 5 and 6), troponin started to trend down and chest pain resolved in 24 hours. Two days later, the patient was discharged with normal ECG (Figure 7).
case_images: Patient's ECG on discharge ECG is normal with no T wave or ST segment abnormalities.
case_images: CRIONM2020-4151474.007.jpg
case_images: PMC7391081_01_CRIONM2020-4151474.007.jpg
case_images: fig7
case_images: T wave abnormalities (Figures 5 and 6), troponin started to trend down and chest pain resolved in 24 hours. Two days later, the patient was discharged with normal ECG (Figure 7).