A patient with simultaneous anterior and inferior ST-segment elevation after percutaneous coronary intervention

ST Segment Elevation

“…Although many STEMI cases observe the principle of clustering of STE within a set of contiguous leads, some exceptions still occur, either presenting with STE in both precordial and inferior leads, or STE merely outside the expected leads. On one hand, some scenarios about STE spreading over precordial and inferior leads are the following: 1) acute distal occlusion of a long (wrapping/dominant) LAD [51,52], as well as its very uncommon counterpart, namely the acute distal occlusion of a long posterior descending artery, which wraps up the tip of the heart to flush the apical segment of the anterior wall [53], 2) acute proximal occlusion of a short (non-dominant) RCA, featuring STE in leads DII,DIII,aVF,V1-V3 (whereabouts the decreasing order of STE amplitude from V1 towards V3 opposes against the increasing order of STE amplitude from V1 towards V3(V4) exhibited by LAD occlusion) [54,55,56], 3) acute proximal ones, by slowing the local depolarization) [42], then catches up with the T wave and finally all blend together. When fast enough, coronary reperfusion allows the ST segment to fall quickly to the baseline, while the T wave pursues its way back to normality, either by running anew through a hyperacute pattern [62], or by testing a negative shape, which lasts but a few days.…”