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Figure 2 Serial changes are depicted between the prehospital (left) and initial hospital (right) ECG in a patient with chest pain. The prehospital ECG shows ST segment elevation in leads V1 to V4, with ST segment sagging and T wave inversion in leads II, III and aVF. On the initial hospital ECG, obtained 23 min after the prehospital tracing, ST segment elevation has resolved and ST-T wave abnormalities are less pronounced in the inferior leads, whereas ST segment sagging is now evident in leads V4 and V5.