Abnormal ECG Findings in a Young Patient With Unexplained Shortness of Breath.

A 30-year-old male patient presented reporting shortness of breath at rest for the past 6 months. He denied other symptoms or family history of heart disease. He had been a smoker for the past 10 years, but had quit recently. Baseline ECG (Figure 1) demonstrates sinus bradycardia with QR complexes in lead II, III, and aVF associated with concave ST elevation and an rs complex in aVL associated with ST depression and negative T waves. Noteworthy, as well, is the presence of RS complexes in the septal precordial leads (V2 and V3) associated with remarkable q waves and low-voltage R waves in V5 and V6. In addition, there is a notch in the middle portion of the QRS in lead II and aVF and a diphasic T wave in V2. What is the most likely underlying etiology to explain the baseline ECG findings? Please turn the page to read the diagnosis. Khalid Bakr, MD Julia Grapsa, MD, PhD Antonio Sorgente, MD, PhD