A 56-year-old physician was referred to our coronary care unit (CCU) for urgent coronary intervention. His epigastric pain had started 2 hours earlier, and the 12-lead electrocardiogram (ECG) recorded thereafter by the ambulance team in his home is shown in Figure 1A. During transport, he developed a wide QRS complex rhythm at 65 beats/min (Figure 1B), followed by episodes of ventricular fibrillation, which terminated with direct current shocks. On arrival at the CCU, he was conversant for a short period, but his condition then rapidly deteriorated and he became unconscious. Consecutive ECG recordings demonstrated further widening of the QRS complexes (Figure 1C and D).