NSTEMI of Infero-Posterior wall with WPW ECG Pattern- Importance of St-Segment Depression In Anterior Leads-A Case Report

Wolff-Parkinson-White Syndrome is a type of pre-excitation syndrome and Inferior lead pseudo-infarct Q waves are a common finding in the Wolff-Parkinson-White (WPW) syndrome. Pseudo-infarct Q waves in the inferior leads are associated with positive or isoelectric T waves in a large number of patients. This characteristic Q wave-T wave vector discordance results from secondary repolarisation changes due to altered ventricular activation. As a corollary, the presence of T wave inversion with inferior lead Q waves and a short PR interval is strongly suggestive, but not pathognomonic of inferior ischemia. The Authors describe an interesting case of Non ST-Elevation Myocardial Infarction involving the inferoposterior wall needing percutaneous coronary intervention of a tight proximal to mid Right coronary artery lesion in a patient whose ECG showed WPW pattern with significant ST-Segment depression in anterior leads V1 to V5 . Significant ST-Segment depression in anterior chest leads with WPW pattern should not be ignored as secondary or discordant ST-T change. Otherwise, Acute Myocardial Infarction may be missed.