This characteristic EKG pattern is important to recognize, as it is correlated to patients with critical stenosis of the proximal LAD.

• Deep symmetic t-wave inversions or biphasic t waves in the pre-cordial leads (typically V2 and V3 but can be seen in V1, V4-V6)

• No/minimal ST elevation
• Maintainence of precordial R wave progression
• No pathologic precordial Q waves

The intitial study showed that all of the 180 patients Dr. Wellen admitted who had this characteristic finding had significant disease in the proximal LAD, from 50-100%.

This patient presented with chest pain and was taken to the cath lab where he was found to have an 85% stenosis of his proximal LAD.

http://www.ncbi.nlm.nih.gov/pubmed/19130419