Prominent precordial T waves as a sign of acute anterior myocardial infarction: electrocardiographic and angiographic correlations

In clinical practice, one occasionally encounters patients with symptoms lasting for relatively long time showing prominent positive T waves combined with minor ST elevation, or ST depression in the precordial leads. This electrocardiographic pattern has been described as Sclarovsky-Birnbaum grade 1 ischemia. We present 3 cases of patients with predominantly grade 1 ischemia, in whom the culprit site was in the left anterior descending coronary artery. The electro/pathophysiologic mechanisms of these electrocardiographic patterns are discussed.