PMC10290533_01
1A. Admission ECG showing sinus tachycardia; QTc=509 ms (120 bpm, QT 
interval: 360 ms). No ST changes are seen.. 1B. ECG at decompensation, showing sinus tachycardia; QTc=580 ms (156 
bpm, QT interval: 260 ms). ST elevation is seen during V4 - V6, I, II, aVL and 
aVF, with reciprocal changes during V1, aVR and III, in keeping with a large left-circulation ST-elevation myocardial infarct.. 1C. ECG 15 minutes post intravenous calcium replacement. Sinus tachycardia 
is seen; QTc=637 ms (90 bpm, QT interval: 520 ms). ST elevation has resolved 
and no Q waves are seen.. ECG = electrocardiograph. QTc = corrected QT interval. bpm = beats per minute
SAJCC-35-1-386-fig1.jpg
PMC10290533_01_SAJCC-35-1-386-fig1.jpg
F1
Trousseau's sign during blood pressure  measurement and a prolonged corrected QT (QTc) interval (360 ms) on  the electrocardiograph upon admission (Fig. 1A). The patient became  unexpectedly unstable 24 hours post admission and developed acute  pulmonary oedema that required ventilation. ST elevation in keeping with an acute  myocardial infarction (Fig. 1B). Serum troponins were initially within  the normal range (40 ng/L), but later became markedly elevated (peak:  4 358 ng/L). The patient  stabilised before the thrombolytic agent could be administered, with  complete resolution of the ST elevation and no residual Q waves (Fig. 1C). 
Technetium (99mTc) sestamibi stress test scan, showing no perfusion defects.. SA = short axis. HLA = horizontal long axis. VLA = vertical long axis. INF = inferior. ANT = anterior. SEP = septum. LAT = lateral wall
SAJCC-35-1-386-fig2.jpg
PMC10290533_01_SAJCC-35-1-386-fig2.jpg
F2
A technetium sestamibi scan of the patient's myocardium revealed no  perfusion defects (Fig. 2), whereas a non-contrast CT scan of the chest  revealed no coronary artery calcification or plaques.