Current role of electrocardiography in acute ischemic syndromes: is it an outdated technique?

We present the case of a 59-year-old woman with intense precordial pain 1 h in duration, arterial pressure at 136/84 mm Hg, and cardiac frequency at 72 BPM. The ECG (Figure 1A) showed a preinfarction stage with level 3 ischaemia (pointed T, elevated ST, and disappearance of the S wave) due to occlusion of the right coronary artery (TII>TI) distal to the first right acute marginal one (depressed ST in V1-V3). The second level block, Mobitz type II, indicated that the inferior part of the atrioventricular node (AVN) was involved in the ischaemic process (Figure 1A). Treatment with aspirin and nitroglycerin began. During the trip to the referred hospital, various arrhythmias were registered (Figure 2) in a short time: also a sinus rhythm of 75 BPM with a PR of 0.34 s; shortly after, typical Wenckebach tracing with alternate beats was observed with an atrial frequency of 110 BPM and varying ventricular frequency of 40-55 BPM. The first P wave conducted at a PR interval avoid the undesirable effects of beta-adrenergic receptor blocker medicines, which we would usually administer if not suspecting use of this narcotic.