Another single frontal lead ST-segment elevation pattern in a patient with lateral myocardial infarction: A reverse Aslanger mechanism?

The standard ST-elevation (STE) myocardial infarction (MI) criteria require STE in at least two contiguous leads. While this rule enhances specificity, it can reduce sensitivity and may delay recognition of clinically significant infarction patterns. We present a patient with lateral myocardial infarction in whom the initial electrocardiogram (ECG) showed STE confined to a single lead, aVL, not meeting the two‑lead requirement. Coronary angiography revealed multivessel disease with a culprit lesion in the left circumflex artery, successfully treated with percutaneous coronary intervention. This case illustrates a variant of the previously described Aslanger's pattern, with a reverse mechanism, where the ST-vector of lateral infarction is shifted by coexistent subendocardial ischemia, projecting solely onto lead aVL. Recognition of such single‑lead STE patterns is critical for timely diagnosis and treatment. Our findings support a flexible, pathophysiology-based approach to ECG interpretation, as emphasized by the emerging occlusion MI paradigm.