'Pseudonormalisation' of the 'normal variant pattern' on the ECG of black subjects after intermittent acute myocardial ischaemia. A case report.

A middle-aged urbanised black man with unstable angina pectoris showed unusual findings on serial resting ECGs recorded during episodes of chest pain, as well as during symptom-free intervals. The 'normal variant pattern', known to occur in blacks, was recorded in the absence of angina; in a white patient with chest pain it would have been considered as being due to a possible hyperacute myocardial infarction. During repeated episodes of severe angina, 'pseudonormalisation' of the 'normal variant pattern' was seen but the pointer to myocardial ischaemia was the simultaneous occurrence of ST-segment depression, Selective coronary arteriography delineated critical lesions in both the left anterior descending and dominant left circumflex coronary arteries. Coronary artery bypass surgery was successful. The importance of recognition of the 'normal variant pattern' in the black population in which the incidence of atherosclerotic coronary artery disease is rising, is emphasised.