[Vexillology on the electrocardiogram. South Africa´s flag sign]. / Vexilología en el electrocardiograma. Signo de la bandera de Sudáfrica.

The electrocardiogram (ECG) is a test that will allow making life-saving decisions. It has different patterns, and differential diagnoses, like the pattern of acute coronary syndrome with an elevation of the high lateral ST segment, which is called the sign of the flag of South Africa. We present the case of a 44-year-old patient presented with typical chest pain; the ECG showed ST-segment elevation in the DI, DII, AVL - V2, and ST depression in DIII, corresponding to an acute coronary occlusion with a compromise of the lateral segment of the heart. This ECG pattern is known as the flag sign of South Africa. The early recognition allowed the decision to perform immediately pharmacological reperfusion therapy and rescue angioplasty.

[Advanced heart failure due to coronary aneurysms]. / Falla cardiaca avanzada por aneurismas coronarios.

We present the case of a 61 years old man with hypothyroidism, hypertension, type 2 diabetes mellitus, and ischemic cardiopathy, who was admitted with a diagnosis of non-ST elevation myocardial infarction. The coronary angiography describes coronary ectasia with giant aneurysm and slow flow in the right coronary and aneurysm with slow flow anterior descending coronary. The echocardiogram shows contractility disorders with severely decreased left ventricular ejection fraction (20%) despite optimal medical management. This case presents a patient with ischemic heart disease and advanced heart failure secondary to coronary aneurysm, the proposed optimal treatment was a heart transplant given the disease's progression.