World Cardiology Conference 2026

Abstract

 Among the various manifestations of electrocardiogram (ECG) for diagnosis of acute transmural myocardial infarction (ATMI), broad-based and tall tented T-waves, called hyperacute T-waves, may be the earliest and the only ECG sign of ATMI. As it is a rare ECG sign of ATMI, and because of its transient nature in the very early stage, quick identification of such ECG sign should trigger immediate evidence-based reperfusion therapeutic strategy to maximize myocardial salvage and survival of patients in the acute phase and in the long term. A male, 81 years of age with sudden onset typical ischemic chest pain, having history of chronic smoking, presented to the Heart Attack Centre (HAC) of SKY Hospital and Research Centre. The only ECG sign on presentation at the HAC was hyperacute T-wave changes in the chest leads, V2-V6. Cardiac injury marker (troponin T) done on presentation was normal. A simultaneously done bedside echocardiogram showed regional wall motion abnormality (RWMA) in the territory of left anterior descending (LAD) artery. Based on these findings, the patient was thrombolysed with intravenous (IV) tenecteplase with simultaneous administration of dual antiplatelet drugs and subcutaneous enoxaparin injection within 10 minutes of presentation to the HAC. His chest pain was completely relieved within minutes of the first-aid medication. Post-thrombolytic ECG showed near normalization of the T-wave changes. Subsequent coronary angiography showed 20% recanalization of proximal LAD artery obstruction which has probably helped save the myocardium in jeopardy and thereby reduced further damage of the myocardium. The culprit artery was stented with complete reperfusion of the affected myocardium.