Normal electrocardiogram with total occlusion of the left anterior descending coronary artery

Area of Science:

• Cardiology
• Clinical Electrocardiography
• Interventional Cardiology

Background:

• Total occlusion of the left anterior descending (LAD) coronary artery typically presents with ST-segment elevation on an electrocardiogram (ECG).
• This ECG finding is a hallmark of acute anterior myocardial infarction, guiding immediate diagnosis and treatment.
• The absence of collateral circulation in such cases usually portends a significant myocardial injury.

Observation:

• We present a unique case of a patient with angiographically confirmed total occlusion of the LAD artery.
• Despite the critical coronary blockage and lack of collateral vessels, the patient exhibited a persistently normal surface ECG throughout hospitalization.
• This observation is highly unusual and contrasts with the expected electrocardiographic manifestations.

Findings:

• The patient's normal ECG findings in the presence of a completely occluded LAD artery and no collaterals represent a significant deviation from established diagnostic criteria.
• Angiography revealed a critical stenosis requiring intervention.
• Successful percutaneous transluminal coronary angioplasty (PTCA) with stent placement was performed, restoring blood flow.

Implications:

• This case highlights the potential for discordant findings between ECG and coronary angiography in acute coronary syndromes.
• It suggests that a normal ECG cannot definitively rule out significant LAD occlusion, necessitating a low threshold for further investigation in specific clinical contexts.
• Further research may explore the underlying mechanisms contributing to the absence of ECG changes in severe coronary artery disease.