New-Onset Retrosternal Chest Pressure

A previously healthy 39-year-old male cigarette smoker came to the emergency department because of the new onset of retrosternal chest pressure. The electrocardiogram recorded on admission showed sinus rhythm at a rate of 64 beats per minute, nondiagnostic Q waves in the inferior leads (II, III, and aVF), and inferior ST-segment elevation of 0.5 mm (0.05 mV) when compared to the PR segment or the TP segment. The inferior ST segments were normally concave upward, and there was no reciprocal ST depression in lead I or lead aVL (Figure 1) (1).