see also:

• an approach to the ECG with ST elevation
• ECG diagnosis of AMI

• deep, prominent T wave inversion or biphasic T waves in leads V2-4 in the presence of persistent R waves
• probably represents transient STEMI due to occlusion of the LAD that, before the ECG, spontaneously opened or received collateral flow.
• this is associated with a high incidence of critical narrowing of the proximal LAD and thus high risk for reocclusion with recurrent STEMI and potential for sudden death.
• these patients should be referred to cardiology urgently for angiography - stress testing may cause sudden death!
• see also Life in the fast lane's page on Wellen's syndrome with ECG

• a similar scenario may occur with a very tight right coronary artery
• the ECG shows upward bowing of the ST segments of the inferior leads with symmetrically inverted T waves
• perhaps consider this next time you are looking for that S1 QIII TIII pattern of a PE