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There is striking ST segment elevation in V1 and V2, with ST depression in V3-V6 as well as I, II, and aVF. There is also a wide QRS. One might think this represents acute STEMI, or Bundle branch block with discordant ST segments and suspicously concordant T-waves.
However, closer inspection reveals a very short PR interval and that the wide QRS is due to a slurred upstroke (delta wave).
This is WPW, which is well known to produce pseudoinfarction patterns.
The patient had a positive troponin, underwent cath which showed completely clean coronaries, and then underwent EP testing which revealed that, in atrial fibrillation, he has an R-R interval as short as 220 ms, which is dangerously short. Ablation was planned for a later date.