Scenario: This 12-lead electrocardiogram (ECG) was obtained during prehospital transport of a 72-year-old male with a history of coronary artery disease. He had called 911 to report chest pain. After the ECG, the patient experienced ventricular fibrillation and was resuscitated in the ambulance. At the hospital, the initial cardiac workup indicated myocardial infarction (MI), documented by a rise in cardiac troponin levels (> 0.10 ng/mL). Twelve hours later, the patient was transferred to a nearby facility to undergo a coronary angiogram that revealed 100% occlusion of the left anterior descending artery and a coronary stent was placed. After a 9-day recovery, he was discharged home on an extensive cardiac rehabilitation program.

This ECG shows normal sinus rhythm with left ventricular hypertrophy (LVH), which is associated with secondary repolarization changes seen as inverted T-waves confounding interpretation of ST/T waveforms for acute coronary syndrome. Clinically,...

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