The most obvious abnormality is ST segment elevation in lead aVR with diffuse ST depression in most other leads (least in aVL but obvious in all others).
There is sinus tachycardia with rate ~120, normal QRS axis, normal P wave morphology, no AV nodal block, and a narrow QRS complex. T wave morphology is normal and QT segments are grossly normal (not calculated).
The cause of this ECG appearance could be:
- LMCA stenosis
- Proximal LAD stenosis
- Severe triple vessel disease
- Myocardial oxygen consumption / demand mismatch
This patient had a Hb of 49 g/L and a troponin of over 4200 ng/L. His other laboratory markers were consistent with a haemolytic process and he required joint care between haematologists and cardiologists. He spent a few days in ICU as he progressed to renal failure and required renal replacement therapy. His coronary angiogram upon stabilisation of other medical issues revealed a proximal LAD stenosis.