Acute myocardial infarction caused by left anterior descending artery occlusion presenting as inferior ST elevation and anterior ST depression

Abstract

a b s t r a c tWe report a case of acute myocardial infarction caused by left anterior descending artery occlusion presenting as ST elevation in the inferior leads and ST depression in the precordial leads, suggesting an involvement of the right coronary artery (RCA). However, coronary angiography (CAG) showed a complete occlusion of the proximal left anterior descending (LAD) coronary artery and collaterals from the left circumflex coronary artery and the RCA. Although he underwent primary percutaneous coronary intervention (PCI), he had chest pain at four days after primary PCI. His electrocardiogram (ECG) showed precordial ST elevation, suggesting an involvement of the LAD. Emergent CAG showed a complete occlusion of the proximal LAD without collaterals, but his ECG showed precordial ST elevation that was different from ST changes seen on admission. These unusual ST-segment changes might be associated with a weaker anterior ischemia due to collaterals and a strong inferior ischemia due to wrapped LAD artery. <Learning objective: Inferior ST elevation and anterior ST depression generally indicate inferior myocardial infarction. However, the unusual ST-segment changes seen in this patient with anterior myocardial infarction might be associated with a weaker anterior ischemia due to collaterals and a strong inferior ischemia due to wrapped left anterior descending artery.>

Wrapped Left Anterior Descending Artery Presenting As Inferior Myocardial Infarction: Case Report and Review of the Literature

“…Exclusion criteria were studies with no measurable outcomes or clinical follow-up. The reported outcomes of cases similar to ours are displayed in Table 1 [3,4,[11][12][13].…”

“…The ECG changes in different leads help to gauge the thrombosed vessels in the setting of acute MI. Simultaneous anterior and inferior MI due to distal LAD occlusion has been described; however, isolated inferior STEMI presentation based on LAD occlusion alone is rarely reported [ 4 ]. A “wrapped LAD” is considered an anomalous LAD that wraps around the apex of the heart and perfuses at least one-fourth of the inferior wall of the left ventricle (LV).…”

“…Kim et al [3] February 2019 Female 54 Ventricular fibrillation II, III, avF, V2-V5 Honda et al [4] December 2013 Male 53 Chest pain ST depressions in V2-V5, STEMI in II, III,…”

Remodeled eX vivo muscle engineered tissue improves heart function after chronic myocardial ischemia

“…The respiration rate was approximately 110 per minute, with an inspiratory pressure of 17 to 18 cm H 2 O. Thereafter, the occlusion of the left anterior descending (LAD) artery was performed using a permanent 8–0 prolene suture (Ethicon, Norderstedt, Germany), with silicon tubing (1 mm OD) placed on top of the LAD, 2 mm below the border between the left atrium and LV 46 . During the operation, mice were monitored with a rectal probe to keep body temperature between 36.8 and 37.2 °C using a heat pad.…”

Clinical Paradox: Anterior Wall Myocardial Infarction with Predominant Inferior ST Elevation and No Variation in Coronary Anatomy in a PAI-1 Homozygote

“…In case of combined ST elevation in both inferior and anterior leads, these changes can be due to a distal occlusion of a “wrapped” left anterior descending artery (LAD) or a two-vessel disease [ 1 ]. There are several studies and case reports presenting the “wrapped” LAD being the cause of ST elevation in inferior and anterior leads, defining the “wrapped” LAD as a LAD from a postreperfusion coronary angiogram that perfuse at least one-fourth of the inferior wall of the left ventricle in the right anterior oblique projection [ 2 – 8 ]. According to a recent study, hereditary thrombophilia was the most frequently encountered atypical etiology for acute myocardial infarction in young people, accounting for 15% of cases [ 9 ].…”