JACC. Case reports · 2026
"Left Main" Pattern Electrocardiogram: A Diagnostic Trap for Cardiologists.
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Ting Kwok Grace Hoi, Ong Kevin, Chi Wai Kin, Kam Kevin Ka-Ho
Аннотация
BACKGROUND: Acute Stanford type A aortic dissection may mimic left main coronary artery occlusion on electrocardiography (ECG) yet requires fundamentally different management.
CASE SUMMARY: A 63-year-old woman presented with sudden chest pain, collapse, and cardiogenic shock. ECG showed ST-segment elevation in aVR with diffuse precordial ST-segment depression, suggesting left main coronary occlusion and prompting consideration of urgent coronary angiography. Examination revealed severe aortic regurgitation and a carotid intimal flap. Echocardiography and computed tomography aortography confirmed extensive Stanford type A dissection from the aortic root to the renal arteries with patent coronary ostia.
DISCUSSION: This case shows that global subendocardial ischemia from acute severe aortic regurgitation, shock, and malperfusion can reproduce a "left main" ECG pattern without epicardial coronary occlusion.
TAKE-HOME MESSAGES: When ECG suggests left main coronary artery occlusion, meticulous clinical assessment and urgent imaging are essential to exclude aortic dissection. The Aortic Dissection Detection Risk Score is a useful tool for identifying high-risk features of acute aortic dissection.
CASE SUMMARY: A 63-year-old woman presented with sudden chest pain, collapse, and cardiogenic shock. ECG showed ST-segment elevation in aVR with diffuse precordial ST-segment depression, suggesting left main coronary occlusion and prompting consideration of urgent coronary angiography. Examination revealed severe aortic regurgitation and a carotid intimal flap. Echocardiography and computed tomography aortography confirmed extensive Stanford type A dissection from the aortic root to the renal arteries with patent coronary ostia.
DISCUSSION: This case shows that global subendocardial ischemia from acute severe aortic regurgitation, shock, and malperfusion can reproduce a "left main" ECG pattern without epicardial coronary occlusion.
TAKE-HOME MESSAGES: When ECG suggests left main coronary artery occlusion, meticulous clinical assessment and urgent imaging are essential to exclude aortic dissection. The Aortic Dissection Detection Risk Score is a useful tool for identifying high-risk features of acute aortic dissection.