A 64-year-old is brought in by family from home. He had been experiencing 8/10 intermittent, non-radiating, substernal chest pressure since last night. Upon arrival in the emergency department his vitals signs are all within normal limits and his exam is physical exam is unremarkable.
His initial ECG performed immediately upon arrival is shown:
The usual cardiac work-up is initiated and the patient’s pain resolves with treatment. His initial set of cardiac enzymes are normal.
A repeat ECG is performed after the pain had resolved.
1. What is your interpretation of the second ECG?
2. What anatomic lesion might a cardiac catheterization reveal?