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Left Circumflexus Coronary Artery Total Occlusion with Clinical Presentation as NSTEMI and Acute Pulmonary Oedema

Budi Yuli Setianto1, Nahar Taufiq, Heri Hernawan

  • 1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University - Sardjito Hospital, Yogyakarta, Indonesia. Department of Internal Medicine, Faculty of Medicine, Gadjah Mada University - Sardjito Hospital, Yogyakarta, Indonesia. budyuls@gmail.com.

Acta Medica Indonesiana
|April 29, 2017
PubMed

Insights

ST-elevation myocardial infarction (STEMI) diagnosis relies on ECGs. However, left circumflex artery occlusions, often missed as NSTEMI, can delay critical reperfusion therapy.

Area of Science:

  • Cardiology
  • Medical Diagnostics

Background:

  • Current acute coronary syndrome (ACS) guidelines use electrocardiograms (ECGs) to differentiate ST-elevation myocardial infarction (STEMI) from non-ST-elevation myocardial infarction (NSTEMI)/unstable angina (UA).
  • Prompt reperfusion therapy is crucial for STEMI patients to restore blood flow and minimize myocardial damage.

Observation:

  • ST-segment elevation on a 12-lead ECG is the hallmark for diagnosing acute total coronary occlusion and transmural myocardial infarction.
  • Left circumflex (LCx) coronary artery occlusions frequently present as NSTEMI due to the absence of significant ST-elevation on standard ECGs.
  • Fewer than 50% of patients with total LCx occlusion exhibit ST-segment elevation, leading to delayed diagnosis and treatment.

Findings:

  • A 77-year-old woman was diagnosed with NSTEMI based on ECG findings of ST-segment depression in leads V2-V5.
  • Coronary angiography revealed a total occlusion in the LCx artery as the cause of her symptoms.

Implications:

  • This case highlights the diagnostic challenge of LCx artery occlusions presenting atypically.
  • Delayed diagnosis in such cases can impede timely reperfusion therapy, underscoring the need for heightened clinical suspicion.
  • Revisiting diagnostic criteria for ACS may be warranted to improve detection of LCx occlusions.

Keywords:
Left CircumflexST-elevation acute myocardial infarction (STEMI)culprit lessiontotal occlusion

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