His ECG (displayed again here) shows left axis deviation (-45 degrees), but is otherwise unremarkable. The echocardiogram revealed an akinetic posterior wall and the cardiac enzymes were elevated. The coronary angiogram revealed a totally occluded non-dominant circumflex coronary artery. This case illustrates that the ECG may be unremarkable and still within normal limits in a group of patients experiencing a myocardial infarction (approximately 10% of patients with a documented infarction). This is most likely to occur when the infarction is small and/or involves the posterior wall. The case also demonstrates the importance of heeding the admonition to “treat the patient and not the electrocardiogram”. This may sound like a cliché, but is truly worth remembering.