Now You See it, Now You Don't

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Author(s) T.A. Simmers, A.A.M. Wilde
NHJ edition: 2005:5,195
These Rhythm Puzzles have been published in the Netherlands Heart Journal and are reproduced here under the prevailing creative commons license with permission from the publisher, Bohn Stafleu Van Loghum.
The ECG can be enlarged twice by clicking on the image and it's first enlargement
Figure 1

An otherwise healthy 66-year-old male was referred with complaints of central chest pain. He was not on any medication, and there were no risk factors for coronary artery disease. Pain invariably occurred at rest and subsided spontaneously within approximately 15 minutes. Physical examination, laboratory testing, resting ECG and stress test were all within normal limits; myocardial perfusion scintigraphy revealed no ischaemia. During hospitalisation the patient experienced a recurrence, at which time an ECG (figure 1) was taken. En route to emergency coronary angiography the ECG normalised and the symptoms resolved. Angiography showed no significant coronary stenosis.

  • What is the most likely diagnosis?
  • What diagnostic and/or therapeutic measures should be taken?