Evolution of a T wave

55-year-old woman presented to the emergency departent with a chief complaint of chest pain. Her discomfort ad started earlier in the morning and soon became more ntense and unrelenting. She had a history of hypertension, ight hemispheric stroke, and hyperlipidemia. An initial electrocardiogram (ECG) showed the classic igns of an acute anterior wall myocardial infarction (Figure ). There is ST segment elevation throughout the precordial eads, reaching a maximum height of about 9 mm in lead 4. The T waves are upright in leads V1 through V4. Q aves in the inferior limb leads (II, III, AVF) suggest an old nferior wall infarction. Left ventricular hypertrophy is resent with increased voltage in AVL (17mm). ST-segent depression with asymmetrically inverted T waves in eads I and AVL imply a strain pattern due to hypertrophy, ut this had already been documented on a prior baseline CG. Left atrial enlargement is also indicated by a broad P ave with a wide negative deflection in V1. The patient was promptly brought to the cardiac catheerization laboratory where a total acute occlusion of the left nterior descending artery was discovered and then opened y balloon angioplasty. Of note, the right coronary artery ad the appearance of a chronic total occlusion filling from ell-developed collateral circulation from the left coronary rtery. The peak troponin level was 47.6 ng/mL. The next orning, the ECG in Figure 2 was obtained. What is hapening here?