A 59-year-old man with a 4-year history of hypertension presented to the outpatient clinic and complained of paroxysmal chest pain accompanied by palpitation and sweating the previous day. It was relieved after 5 min of rest and did not appear again. On presentation, the patient was comfortable without any symptoms, and the vital signs were as follows: blood pressure of 139/90 mmHg, heart rate of 65 beats per minute and respiratory rate 14 of beats. His cardiopulmonary examination was normal. The jugular veins did not distend. The ECG on presentation demonstrates a sinus rhythm of 65 beats per minute; biphasic T waves in leads V2 and V3 (Figure 1A). His tropo-nin T was <0.05 ng/ml (reference range 0-0.4ng/ml). For further diagnosis, he was admitted to the ward and underwent 24-h Holter monitoring. The complete ECG evolution from Wellens into ventricular tachycardia was recorded by the Holter monitor. The ECG findings are in order as follows: biphasic T waves in leads V2 and V3; pseudonormalized T waves; high T waves; elevated ST-segment in leads V2 and V3 resembling the back of a bow; elevated ST-segment in lead V2 resembling tombstone; ventricular arrhythmia, including ventricular premature beats, paired ventricular premature beats and ventricular tachycardia (Figure 1B). The patient denied any episode of chest pain and other symptoms during wearing a Holter monitor. Despite the lack of symptoms, the patient was still transferred for urgent coronary angiography because of the high risk of acute myocar-dial infarction and sudden death.
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