[Upright T-wave in V1 as predictor of significant coronary artery disease]

The 56-year-old man came to our emergency department because of heartburn, chest tightness and sweating. Cardiovascular risk factors were obesity and hypertension. Clinical examination revealed no significant abnormalities.

Laboratory results showed no pathologies except a slightly elevated creatinine (1,19 ng/dl). Troponin I ultra sensitive was negative (< 0,006 ng/ml), CK and CK-MB not elevated. The 12-channel-ECG revealed sinus rhythm with a heart rate of 68/min, a non-significant ST-elevation in V2 as well as elevated T-waves in V1 and V2. The T-wave in V1 was positive (> 0,15 mV) and bigger than the T-wave in V6.

The patient was monitored at our intermediate-care ward. The troponin level was checked again after about four hours and showed a troponin of 1,519 ng/ml (norm: 0,02 - 0,06 ng/ml). NSTEMI was diagnosed and coronary angiography was performed next morning, demonstrating coronary three vessel disease with 95 % occlusion of the left anterior descending (LAD).

An upright T-wave in V1 can be an indicator for coronary artery disease (CAD). A bigger T-wave in V1 than in V6 can indicate CAD  with LAD  involvement. Therefore, in patients with thoracic pain and a positive T-wave in V1 cardiac ischemia should be considered.