Reciprocal changes as the presenting electrocardiographic manifestation of acute myocardial ischemia

Reciprocal changes are well-recognized electrocardiographic signs often accompanying the ST-segment elevation of acute myocardial ischemia. Their significance and prognostic value have been the subject of many reports. 1–7 In a previous study recording 12-lead electrocardiograms (ECG) in 20 patients during coronary angioplasty, 8 we noted a case in which mild ST depression occurred in the inferior wall leads during left anterior descending occlusion. The precordial leads showed minor T-wave changes that were only recognized after comparison with the baseline ECG. That study inspired the present one, which was performed to determine whether reciprocal changes can be present before or instead of any other sign of acute myocardial ischemia.