Clinical and electrocardiographic trinity at different times in a single patient

Dr. Raimundo Barbosa Barros
Dr. Raimundo Barbosa Barros

Case presentation

MJB, Caucasian, male, 31, tattooist, was admitted in our emergency room (ER) with complaint of prolonged atypical chest pain in August 23-2008 19:30 P.M.
Pathological personal antecedents: carrier of polycystic kidney disease (PKD) and hypertension (using captopril 25mg (3x/day) and hydrochlorothiazide 25mg (1 tablet daily)).

He does not refer syncope, sudden cardiac death (SCD) and heart failure (HF).

Negative familial background for syncope or SCD in firth degree relatives
Physical examination: lucid, BP = 140/100 mmHg, bradycardic (heart rate 40 bpm) regular with hyperphonetic 2nd heart sound A2.
Laboratory: Normal biomarkers and electrolytes.
Echocardiogram: Normal.
Normal coronary angiography (unfortunately, the picture was interpreted erroneously as acute coronary syndrome (ACS). Electrophysiological Study (EPS) with Programmed Ventricular Stimulation (PVS) or Programmed Electrical Stimulation (PES) conducted to polymorphic VT that degenerated into VF.
Implanted Implantable Cardioverter Defibrillator (ICD) was indicated following the last guidelines (Class IIb indication) (Priori 2013).


  1. Which is the ECG diagnosis of the ECG-1 performed at 1st admission?
  2. Which is the ECG diagnosis of the ECG-2 performed at 2nd admission?
  3. Which is the most probable cause of ST segment depression on inferior lateral wall in the ECG-1 performed during the 1st and 3rd admission?


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Auspicios Institucionales
  • Sociedad Argentina de Cardiología
  • Federación Argentina de Cardiología
  • SIAC
  • Asociación Argentina de Cardiología
  • Latin American Heart Rhythm Society
  • Fundación Barceló - Facultad de Medicina