A case of myocardial infarction due to acute left main coronary artery occlusion presenting with peculiar electrocardiographic changes

The International Journal of Cardiovascular Imaging
Atila BitigenMehmet Birhan Yilmaz

Abstract

Myocardial infarction (MI) due to acute obstruction of the left main coronary artery (LMCA) occlusion is a medical emergency, requiring early and prompt diagnosis and revascularization, and unless it is treated, it will frequently result in cardiogenic shock, which has a high fatality rate. Our case focused on a patient, who was transferred to our hospital relatively late due to peculiar ECG. He had acute MI, and was in cardiogenic shock. ECG is the easiest diagnostic method in the early diagnosis of the acute coronary syndromes and in deciding on the early invasive intervention in the high risk group. Before he was sent to us, the patient had an ECG showing right bundle branch block (RBBB) and a AVR ST segment elevation. At the time of the urgent coronary angiography, it was noticed that the LMCA was totally occluded. This case has been presented in order to emphasize that peculiar changes might bring about devastating consequences as in our rare case, showing acute left main coronary artery occlusion, and ST segment elevation only in the AVR on the 12-lead ECG along with upward deflection of ST segment vector might be critical for accurate diagnosis.

References

Apr 1, 1986·The American Journal of Cardiology·J L VacekM R Lewis
Feb 1, 1995·American Heart Journal·B A Bergelson, C L Tommaso
Nov 3, 2001·Journal of the American College of Cardiology·A P GorgelsH J Wellens
Jun 1, 2002·Journal of the American College of Cardiology·J Willis Hurst
Jul 2, 2003·The International Journal of Cardiovascular Imaging·Shekar P Kumar, Asssad Movahed

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Citations

May 21, 2014·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Nihal Tefik, Atila Bitigen

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