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Combined ST Elevation in a Case of Acute Myocardial Infarction: How to Identify the Infarct-related Artery?

Kavitha Balasubramanian1, Balasubramanian Ramachandran1, Anandaraja Subramanian2

  • 1Department of General Medicine, Indira Gandhi Medical College & Research Institute, Puducherry, India.

International Journal of Applied & Basic Medical Research
|August 21, 2018
PubMed

Insights

Identifying the culprit artery in acute myocardial infarction (MI) with combined anterior and inferior ST-elevation is challenging. This case highlights ECG criteria differentiating proximal RCA from LAD occlusion in such MI presentations.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Interventional Cardiology

Background:

  • Acute myocardial infarction (MI) with ST-elevation in both anterior and inferior electrocardiogram (ECG) leads presents diagnostic challenges.
  • Identifying the specific infarct-related artery (IRA) is crucial for timely and effective treatment.

Observation:

  • A middle-aged male presented with acute MI exhibiting ST-elevation in inferior leads (II, III, aVF) and anterior leads (V1-V3).
  • The ECG pattern, specifically ST-elevation in lead III (2.5 mm) and V2/V3 ≥ 1, suggested a proximal occlusion.

Findings:

  • The case demonstrates that specific ECG features can differentiate between proximal versus mid-to-distal occlusions of the left anterior descending (LAD) artery and the right coronary artery (RCA).
  • In this instance, the observed ECG findings pointed towards a proximal RCA occlusion as the IRA.
  • Coronary angiography confirmed the proximal RCA occlusion prior to the patient's discharge.

Implications:

  • Accurate identification of the IRA using ECG criteria can expedite treatment decisions in complex MI cases.
  • This diagnostic approach may reduce the need for immediate invasive procedures in certain scenarios.
  • Understanding these ECG nuances improves clinical management of ST-elevation myocardial infarction (STEMI).

Keywords:
Distal left anterior descending occlusionST elevationinfarct-related arteryproximal artery occlusion

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