Pre-excitation syndrome presenting with acute myocardial infarction.

A male in his mid 50s, chronic smoker and hypertensive for 10 years presented with history suggestive of typical angina, electrocardiographic evidence of pre-excitation and serial elevation of cardiac biomarkers. Serial electrocardiograms showed subtle changes (axis shift, horizontal ST-segment changes) that could be presumptive of an anterior wall myocardial infarction. Speckle tracking echocardiography revealed territorial reduction of longitudinal strain corresponding to the left anterior descending artery with coronary angiography corroborating the same and underwent successful revascularisation. Exercise stress testing showed abrupt and complete disappearance of delta wave and normalisation of PR interval which indicates that the patient has low risk of developing malignant arrhythmias and sudden cardiac death.