Electrocardiogram of a 35 year old man with an acute ST segment elevation anterior wall myocardial infarction 3 days earlier (received thrombolytic treatment) who underwent percutaneous coronary intervention (PCI) and stenting of the mid- left anterior decending (LAD) the following day. Two days later he developed severe, retrosternal chest pain similar to the one on the initial presentation.

Rate 104/min
PR 0.12 sec
QRS 0.08 sec
QT 0.30 sec
QTc 0.38 sec
QRS axis - 15º

Interpretation: Abnormal. Sinus tachycardia. Minor right ventricular conduction delay. Hyperacute ST segment elevation (Pardee wave) in the anterior precordial and lateral leads representing current of injury with reciprocal ST segment depression in the inferior leads.

Within half an hour of the onset of pain the patient developed acute pulmonary edema. Received thrombolytic therapy and "rescue PCI" showed acute reoclussion of the mid LAD which was dilated and stented again. 4 days later, he developed chest pain again, ST segment elevation and reoclussion of the stented LAD. The patient underwent emergency coronary artery bypass grafting.

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