U wave inversion in unstable angina due to left main coronary artery stenosis

Area of Science:

• Cardiology
• Diagnostic Electrocardiography
• Interventional Cardiology

Background:

• Unstable angina is a critical condition requiring prompt diagnosis and intervention.
• Electrocardiogram (ECG) abnormalities can indicate underlying coronary artery disease.
• Left main coronary artery stenosis is a high-risk condition associated with significant morbidity and mortality.

Observation:

• A 50-year-old male presented with recurrent chest pain suggestive of unstable angina.
• Serial ECGs were largely unremarkable, except for one showing isolated U wave inversion during an episode of chest pain.
• The U wave inversion was noted in specific leads (I, V4, V5).

Findings:

• Selective coronary arteriography revealed a critical, isolated 99% stenosis of the left main coronary artery.
• The ECG finding of U wave inversion correlated with severe left main coronary artery disease.

Implications:

• Isolated U wave inversion during chest pain may be a subtle but important indicator of critical left main coronary artery stenosis.
• Early detection and intervention for left main coronary artery stenosis are crucial for improving patient outcomes.
• This case highlights the diagnostic value of ECG in identifying high-risk coronary artery disease patterns.