BMC cardiovascular disorders · 2026
Inferior ST-segment elevation as a diagnostic pitfall in proximal LAD occlusion: insights from a wrapped left anterior descending artery--a case report.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Zhang Yu-Sha, Cao Jin-Qian, Liao Ya-Xin, Zheng Qing-Yun, Bian Zhi-Hua, He Jia, Shen Li, Zhu Qing-Yi, Ouyang Ming-Qi, Tang Jian-Jun, Chen Ya-Qin
Аннотация
BACKGROUND: Electrocardiographic localization of the infarct-related artery in ST-segment elevation myocardial infarction is generally reliable; however, coronary anatomical variants and dynamic ischemic processes may result in misleading initial ECG patterns.
CASE PRESENTATION: We describe a clinical scenario in which isolated inferior ST-segment elevation was the initial ECG manifestation of acute myocardial infarction, while coronary angiography revealed complete occlusion of the proximal left anterior descending artery. Subsequent angiography demonstrated a wrapped left anterior descending artery extending beyond the apex and supplying the inferior wall. Serial electrocardiograms showed a sequential evolution, with resolution of inferior ST-segment elevation after reperfusion followed by the emergence of anterior changes, rather than simultaneous multiterritory involvement.
CONCLUSION: Awareness of this dynamic ECG phenomenon is essential to avoid diagnostic delay in high-risk presentations.
CASE PRESENTATION: We describe a clinical scenario in which isolated inferior ST-segment elevation was the initial ECG manifestation of acute myocardial infarction, while coronary angiography revealed complete occlusion of the proximal left anterior descending artery. Subsequent angiography demonstrated a wrapped left anterior descending artery extending beyond the apex and supplying the inferior wall. Serial electrocardiograms showed a sequential evolution, with resolution of inferior ST-segment elevation after reperfusion followed by the emergence of anterior changes, rather than simultaneous multiterritory involvement.
CONCLUSION: Awareness of this dynamic ECG phenomenon is essential to avoid diagnostic delay in high-risk presentations.