Case 5

This 53 year old man had sudden onset of left sided chest tightness at 1100 hours, associated with sweating, nausea and light headedness. He went to his general practitioner, and had a brief syncopal episode with a systolic blood pressure of 80 mm Hg. He was brought to the Emergency Department, and his initial ECG (with chest pain) was taken at 1236 hours. The initial serum troponin concentration was normal.


He continued to have intermittent sharp discomfort in his left chest. A change in the shape of the QRS complexes on the ECG monitor was observed about two and a half hours after arrival, and a second ECG was taken.


  1. Describe the main changes in these two ECG tracings.

  2. What are the possible diagnoses in this case, and what are your treatment options ?