Darryl Low Wei Jie

MOH Holdings Pte Ltd,
Singapore

Abstract Title: Inferior STEMI Mimic from Atrial Ectopic Rhythm with Atrial Repolarization Wave

Biography: Dr Darryl Low Wei Jie completed his medical undergraduate studies at the National University of Singapore, Yong Loo Lin School of Medicine in 2022. He will begin his specialist training in the Singhealth Emergency Medicine Residency Program in 2026.

Research Interest: The atrial repolarization wave is rarely seen on ECG and has been described in case reports as a mimic of inferior ST-elevation myocardial infarction (STEMI). We present a case of left-sided chest pain associated with an atrial ectopic rhythm and prominent atrial repolarization waves, raising concern for inferior STEMI. A 69-year-old male with a 50 pack-year smoking history and known chronic obstructive pulmonary disease presented with recurrent left-sided chest pain and diaphoresis at rest. The initial ECG in the emergency department demonstrated an atrial ectopic rhythm with ST-segment elevation in the inferior leads and ST-segment depression in the lateral leads. A repeat ECG showed a slight increase in ST-segment elevation, prompting urgent cardiac catheterization. Coronary angiography revealed normal coronary arteries, apart from mild stenosis in the mid left anterior descending artery. Troponin levels remained within normal limits. The patient subsequently had spontaneous rhythm conversion to sinus rhythm, with complete resolution of ST-segment changes on ECG. This case highlights the importance of recognizing atrial ectopic rhythm with atrial repolarization waves as a potential mimic of inferior STEMI, which may help avoid unnecessary invasive procedures.