Normal electrocardiogram in a patient with an acute proximal left anterior descending coronary artery occlusion

We report the case of an acute proximal occlusion of the left anterior descending (LAD) coronary artery, possibly due to exercise-induced dissection, in a previously well 43-year-old man with persistently normal electrocardiograms (ECG) and cardiac enzymes throughout his hospitalisation. In LAD lesions, ECG repolarisation abnormalities usually reflect the underlying acute coronary event; however, despite negative cardiac biomarkers, a typical cardiac history of chest pain prompted coronary catheterisation. The patient underwent percutaneous coronary intervention to the LAD artery with a dissection flap clearly seen. Successful deployment of drug-eluting stents restored coronary perfusion without residual left ventricular damage. The patient recovered well, and was discharged home on secondary preventative therapies. Our case emphasises that a normal ECG and negative cardiac biomarkers should not preclude further investigations in a patient presenting with a classical ischaemic history, as appropriate early invasive management can prove life-saving.