A case of isolated inferior ST segment elevation myocardial infarction due to occlusion of the left anterior descending coronary artery and review of the literature

Year 2013, , 525 - 528, 01.12.2013

Faruk Ertaş Ferhat Özyurtlu Halit Acet Mehmet Zihni Bilik

https://doi.org/10.5799/ahinjs.01.2013.04.0339

Abstract

ST elevation myocardial infarction is a clinic situation usually presents with total occlusion in the coronary artery. The electrocardiography (ECG) at the presentation helps us to diagnose, to guess the occluded coronary artery and to assess the treatment. However, sometimes the ECG could not be enough to guess the occluded coronary artery. Left anterior descending (LAD) coronary artery occlusion resulting in inferior ST-segment elevation without anterior ST-segment elevation is an extremely rare finding. In this study, we presented a case who admitted to the emergency department with a typically chest pain and inferior ST-segment elevation without anterior ST-segment elevation ECG pattern but a total occlusion in LAD in the coronary angiography. J Clin Exp Invest 2013; 4 (4): 525-528

Keywords

Myocardial infarction, electrocardiography, coronary angiography

A case of isolated inferior ST segment elevation myocardial infarction due to occlusion of the left anterior descending coronary artery and review of the literature

Abstract

ST elevasyonlu miyokard infarktüsü genellikle koroner arterde tam tıkanma sonucu oluşan klinik bir durumdur. Başvuru anında çekilen elektrokardiyografi tanı koymak, lokalizasyonun yerini tahmin etmek ve tedaviyi yönlendirmek için bize yardımcı olan en önemli araçtır. Fakat bazen elektrokardiyografi lokalizasyonun yerini tahmin etmek için yeterli olmayabilir. Anterior ST segment elevasyonu olmadan inferior derivasyonlarda ST segment elevasyonu olup da sol ön inen arter darlığı saptanması oldukça nadir bir durumdur. Bu çalışmada acil servise tipik göğüs ağrısı ile gelen, elektrokardiyografide anterior derivasyonlarda ST segment elevasyonu olmadan inferior derivasyonlarda ST segment elevasyonu olan, koroner anjiyografisinde sol ön inen arterde ciddi darlık saptadığımız bir olgu nadir görülmesi nedeniyle sunuldu.

Keywords

Miyokart infarktüsü, elektrokardiyografi, koroner anjiyografi

References

• Engelen DJ, Gorgels AP, Cheriex EC, et al. Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction. J Am Coll Cardiol 1999;34:389-395.
• Sgarbossa EB, Wagner G. Electrocardiography. Text- book of Cardiovascular Medicine. Philadelphia, Lip- pincott-Raven, 1998:1570-1575.
• Blanke H, Cohen M, Schlueter GU, et al. Electrocardio- graphic and coronary correlations during acute myo- cardial infarction. Am J Cardiol 1984;54:249-255.
• Huey BL, Beller GA, Kaiser DL, Gibson RS. A compre- hensive analysis of myocardial infarction due to left circumflex artery occlusion: comparison with infarction due to right coronary artery and left anterior descend- ing artery occlusion. J Am Coll Cardiol 1988;12:1156- 1166.
• Sapin PM, Musselman DR, Dehmer GJ, Cascio WE. Implications of inferior ST-segment elevation accom- panying anterior wall acute myocardial infarction for the angiographic morphology of the left anterior de- scending coronary artery morphology and site of oc- clusion. Am J Cardiol 1992;69:860-865.
• Sasaki K, Yotsukura M, Sakata K, et al. Relation of ST- segment changes in inferior leads during anterior wall acute myocardial infarction to length and occlusion site of the left anterior descending coronary artery. Am J Cardiol 2001;87:1340-1345.
• Aldrich HR, Hindman NB, Hinoara T, et al. Identification of optimal electrocardiographic leads for detecting acute epicardial injury in acute myocardial infarction. Am J Cardiol 1987;59:20-23.
• Zimetbaum PJ, Krishnan S, Gold A, et al. Usefulness of ST-segment elevation in lead III exceeding that of lead II for identifying the location of the totally occlud- ed coronary artery in inferior wall myocardial infarc- tion. Am J Cardiol 1998;81:918-919.
• Kulkarni AU, Brown R, Ayoubi M, Banka VS. Clinical use of posterior electrocardiographic leads: A pro- spective electrocardiographic analysis during coro- nary occlusion. Am Heart J 1996;131:736-741.
• Braat SH, Brugada P, Den Dulk K, et al. Value of lead V4R for recognition of the infarct coronary artery in acute inferior myocardial infarction. Am J Cardiol 1984;53:1538-1541.
• Kontos MC, Desai PV, Jesse RL, Ornato JP. Useful- ness of the admission electrocardiogram for identify- ing the infarct-related artery in inferior wall myocardial infarction. Am J Cardiol 1997;79:182-184.
• Porter A, Herz I, Strasberg B. Isolated right ventric- ular infarction presenting as anterior wall myocar- dial infarction on electrocardiography. Clin Cardiol 1997;20:971-973.
• Zimmerman FH, Cameron A, Fisher LD, Grace N. Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis (Coronary Artery Surgery Study Registry). J Am Coll Cardiol 1995;26:654-661.