Failure of serial electrocardiograms to exclude a large anterior myocardial infarction and the role of transesophageal echocardiogram in acute myocardial infarction

When patients present with acute onset of chest pain suggestive of myocardi al ischemia, immediate clinical decisions regarding thrombolysis, percutane ous transluminal coronary angioplasty, or both are usually based on the his tory and abnormal electrocardiograms and confirmed by the presence of abnor mally elevated cardiac enzymes. However, there are potential limitations of the electrocardiograms and initial cardiac enzymes in the diagnosis and co nfirmation of acute myocardial infarction. We describe the case of a patien t who presented with an acute onset of chest pain and had a normal electroc ardiogram and initial cardiac enzymes yet was found by transesophageal echo cardiography to have a large myocardial infarction.