It is important to identify a patient with left main or severe triple vessel disease since the patient is at high risk for death if there is a sudden obstruction. Nikus et al identified an ECG pattern which can help to recognize such a patient. The authors are from Tampere University Hospital in Finland and Procardia Medical Center in Tel Aviv.

Patient selection: acute coronary syndrome (ACS)


Pattern in the ECG:

(1) transient ST-segment depression

(2) negative T waves, with maximal depression seen in lead V4 or V5


This pattern correlates with acute circumferential subendocardial ischemia.


A patient who shows this pattern on the ECG should be considered for angiography and an intervention to improve coronary perfusion.

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