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'Balanced ischaemia' on ECG in dual territory STEMI

Iswaree Devi Balakrishnan1, Chee Yang Chin1, Louis Teo1

  • 1Department of Cardiology, National Heart Centre, Singapore, Singapore.

Oxford Medical Case Reports
|August 16, 2018
PubMed

Insights

Identifying the cause of ST elevation myocardial infarction (STEMI) can be tricky with multiple blocked arteries. This case highlights

Area of Science:

  • Cardiology
  • Electrocardiography
  • Myocardial Infarction

Background:

  • Electrocardiogram (ECG) changes typically guide culprit lesion identification in ST elevation myocardial infarction (STEMI).
  • Identifying the specific blocked artery can be challenging in cases of multi-vessel coronary artery occlusion.

Observation:

  • A case of dual territory STEMI presented with unexpected ECG findings.
  • These ECG changes were not typical for a single occluded artery.

Findings:

  • The concept of 'balanced ischaemia' was introduced to explain the unanticipated ECG changes in dual territory STEMI.
  • Fundamental electrocardiography principles successfully explained these complex findings.

Implications:

  • This case reaffirms the continued relevance of electrocardiography in diagnosing complex myocardial infarction scenarios.
  • Understanding 'balanced ischaemia' can improve diagnostic accuracy in multi-vessel disease.

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