A 64-year-old man with no history of cardiac disease was resuscitated after an in-hospital cardiac arrest with witnessed chest pain and subsequent ventricular fibrillation. The initial electrocardiogram (ECG) after resuscitation showed junctional bradycardia with ST-segment elevation in the inferior leads (figure 1). A subsequent ECG after 30 minutes showed sinus rhythm with extreme QRS widening and enlargement in the inferoposterior leads (figure 2). An urgent PCI was attempted but the patient's condition deteriorated and electromechanical dissociation occurred. Urgent bedside echocardiogram did not show evidence of cardiac tamponade or acute pulmonary embolism. Arterial blood gas analysis showed a normal serum potassium level. The patient was resuscitated but died before a coronary angiogram could be performed. Autopsy showed an 80% atherosclerotic lesion in a dominant right coronary artery.
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