Combined anterior and inferior ST segment elevation during the exercise stress testing

Area of Science:

• Cardiology
• Diagnostic Electrocardiography
• Interventional Cardiology

Background:

• Exercise stress testing is a common diagnostic tool for coronary artery disease.
• ST elevation during exercise typically localizes to the ischemic region, particularly in anterior leads.
• The interpretation of ST elevation in multiple territories requires careful consideration of coronary anatomy.

Observation:

• A patient presented with exercise-induced ST elevation in both anterior and inferior electrocardiographic leads.
• The patient had no prior history of myocardial infarction.
• Coronary angiography was performed to investigate the cause of the ST elevation.

Findings:

• The coronary angiography revealed a "wrap around" Left Anterior Descending (LAD) artery.
• A significant proximal lesion was identified in the LAD artery.
• This anatomical variation and lesion likely contributed to the diffuse ST elevation pattern.

Implications:

• This case highlights the importance of considering coronary artery anatomy, such as a wrap around LAD, when interpreting exercise-induced ST elevation.
• Diffuse ST elevation may indicate complex coronary artery disease requiring further investigation.
• Understanding these patterns can improve diagnostic accuracy and patient management in cardiology.