JACC. Case reports · 2026
Aslanger Pattern as a Manifestation of Inferior STEMI in Multivessel Coronary Artery Disease.
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Ortiz-Mendiguren Diego, Rivera-Colón Giovanni, Engel-Rodríguez Andrew, Rodríguez-Ospina Luis
Аннотация
BACKGROUND: The Aslanger pattern is a subtle electrocardiographic manifestation of inferior occlusion myocardial infarction that may not meet traditional ST-segment elevation criteria, particularly in the setting of multivessel coronary artery disease.
CASE SUMMARY: A 79-year-old man with known multivessel coronary artery disease presented with intermittent chest pain and was admitted for medical management of suspected unstable angina. Initial electrocardiogram (ECG) showed no acute ischemic changes. During hospitalization, he developed recurrent chest pain with subtle ECG findings consistent with the Aslanger pattern, which was not recognized at the time. Symptoms transiently resolved; however, on the following day, the ECG evolved to demonstrate overt inferior ST-segment elevation myocardial infarction. Emergent coronary angiography revealed left main and 3-vessel coronary artery disease with late stent thrombosis of the mid right coronary artery.
DISCUSSION: This case illustrates how limited inferior wall injury combined with diffuse subendocardial ischemia in multivessel coronary artery disease can alter ST-segment vectors, masking an inferior occlusion myocardial infarction and delaying recognition.
TAKE-HOME MESSAGE: Early recognition of the Aslanger pattern may facilitate timely diagnosis of inferior occlusion myocardial infarction and guide appropriate revascularization strategies in patients with multivessel coronary artery disease.
CASE SUMMARY: A 79-year-old man with known multivessel coronary artery disease presented with intermittent chest pain and was admitted for medical management of suspected unstable angina. Initial electrocardiogram (ECG) showed no acute ischemic changes. During hospitalization, he developed recurrent chest pain with subtle ECG findings consistent with the Aslanger pattern, which was not recognized at the time. Symptoms transiently resolved; however, on the following day, the ECG evolved to demonstrate overt inferior ST-segment elevation myocardial infarction. Emergent coronary angiography revealed left main and 3-vessel coronary artery disease with late stent thrombosis of the mid right coronary artery.
DISCUSSION: This case illustrates how limited inferior wall injury combined with diffuse subendocardial ischemia in multivessel coronary artery disease can alter ST-segment vectors, masking an inferior occlusion myocardial infarction and delaying recognition.
TAKE-HOME MESSAGE: Early recognition of the Aslanger pattern may facilitate timely diagnosis of inferior occlusion myocardial infarction and guide appropriate revascularization strategies in patients with multivessel coronary artery disease.