ABSTRACT
A 65-year-old man came to the hospital because of retrosternal chest pain, and an electrocardiogram was recorded. It showed sinus tachycardia and ST-segment depression in 8 leads with slight reciprocal ST-segment elevation in lead aVR, findings of severe subendocardial ischemia and/or injury. Serum markers confirmed non-ST-segment–elevation myocardial infarction. Despite the development of a systolic cardiac murmur, the patient had an uneventful recovery. Over the ensuing 8 months, the patient had angina pectoris for the first time and gradually developed exertional dyspnea, fatigue, orthopnea, and marked peripheral edema. He returned to the hospital, and another electrocardiogram was recorded. This one was quite different from the first electrocardiogram. Widespread ST-segment depression was no longer seen.
