Dead man sign of ECG: An unique predicting sign of acute coronary syndrome

Coronary artery disease is the most common cause of morbidity and mortality worldwide. Acute coronary syndrome which includes STEMI, NSTEMI and unstable angina commonly diagnosed with the help of 12 lead in ECG in ER with or without elevated biomarkers. Inferior wall myocardial infarction is common cause of ST elevation myocardial infarction with low mortality rate. In this case report, we present a 52 years old male presented to ER with the complain of typical chest pain for more than 2 hours duration. Pain was in center of chest with radiation to back and left arm and associated with excessive sweating. Patient is a known smoker for past 10 years. At presentation Blood pressure was 110/70 mmHg and pulse rate of 55/min. Troponin I level was five times of upper normal limit. Basic investigations including ECG were done at presentation. ECG was showing typical changes of inferior wall myocardial infarction with infarction of right ventricle with hidden unique sign known as dead man sign commonly predict the location of obstruction and course of disease in the setting of acute coronary syndrome.