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The characteristic electrocardiography patterns suggestive of the LMCA as culprit vessel are (1): ST depression in leads II, III or aVF (highest sensitivity 88%), ST elevation in both aVR and aVL (highest specificity 98%), ST elevation in aVR less than the ST elevation in V1 and right bundle branch block and left anterior fascicular block.
The initial 12-lead electrocardiogram showed sinus rhythm with 2:1 AV block, right bundle branch block, left anterior fascicular block, and ST-segment depression in precordial leads V1 to V3 (Figure 1).
Subsequent ECG 19 hours post-presentation revealed 2:1 atrioventricular (AV) block, left anterior fascicular block on the conducted beats and diffuse T wave inversions in leads I, aVL, V2-V6 with a QTc of 743 ms (Fig.