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Danger Ahead: Dynamic Hyperacute T Waves

      Hyperacute T waves were associated with episodes of chest pain during an acute coronary occlusion that culminated in ventricular fibrillation. A 59-year-old African American man presented to our hospital with acute onset substernal chest pressure that awoke him from sleep shortly after 4 AM. The pain was nonpleuritic, radiated to his left shoulder, and was associated with nausea, diaphoresis, and light-headedness. He had a prior history of tobacco smoking (20 pack-years), as well as a history of remote intranasal cocaine use, hypothyroidism, and untreated hepatitis C, which he had contracted through tattooing. His family history was unremarkable. A baseline electrocardiogram (ECG) from 2 years earlier was normal.
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