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© 2013 World Journal of Emergency Medicine Figure 1. First ECG, with the patient complaining of chest pain and dyspnea, showing ST depression in inferior and left precordial leads and elevation in V1 and VR (A). Second ECG, during the transfer to the hospital, showing minimal changes in ST segment (B). Third ECG, before the angiogram, with complete normalization of the repolarization changes (C). The difference in voltage and axis in limbs leads between the fi rst ECG and the rest, probably due to a decrease in impedance secondary to the presence of liquid in the thorax during the immediate phase after near-drowning. We present the case of a 74-year-old man with diabetes and hypertension who had to be rescued owing to a near-drowning syndrome at sea. When he was rescued, he complained of dyspnea and chest pain. An electrocardiogram (ECG) suggested acute coronary syndrome (ACS) affecting the left main coronary artery. Therefore, he was referred to our hospital for urgent coronary angiography. Arriving at our hospital, the patient was asymptomatic, but his blood pressure and saturation were normal. The ECG (Figure 1) showed normalization of previous anomalies. Besides, an echocardiogram showed nothing abnormal, and a blood sample was normal and served as a cardiac marker. Angiogram showed normal coronary arteries. After the procedure, the patient remained asymptomatic without an increase of cardiac enzymes, and he was discharged from the hospital after three days. The initial response to immersion is apnea and aspiration of water, provoking a syndrome of respiratory failure and changes in serum electrolytes. This is frequently associated with hypothermia, which can lead to cardiac damages, mainly, conduction disturbance and ventricular arrhythmia. [1]

ECG after near-drowning mimicking acute coronary syndrome with left main coronary artery involvement.