A patient with acute myocardial infarction with electrocardiogram Aslanger's pattern
Ming-Hao Liu1, Hao Li2, Ang Li3
1Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, CAMS&PUMC. No.167 North Lishi Road, Xicheng District, Beijing, China.
Insights
Aslanger's pattern on ECG can indicate acute inferior myocardial infarction with critical coronary artery blockages. Prompt evaluation and revascularization are crucial to prevent adverse outcomes in these high-risk patients.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
Background:
- Aslanger's pattern in electrocardiograms (ECG) suggests acute inferior myocardial infarction (AMI) potentially linked to critical coronary artery stenoses.
- This pattern necessitates careful evaluation of revascularization timing, as it signifies a risk equivalent to ST-elevation myocardial infarction (STEMI).
Observation:
- A 62-year-old male presented with exertional chest pain, and ECG revealed Aslanger's pattern, indicative of acute non-ST-segment elevation myocardial infarction (NSTEMI).
- Coronary angiography identified severe stenoses in the left main (LM) and left anterior descending (LAD) arteries.
- The patient underwent successful implantation of three drug-eluting stents.
Findings:
- The case confirms that Aslanger's pattern on ECG, characterized by specific ST-segment and T-wave changes, can be associated with severe LM and proximal LAD stenosis.
- Post-revascularization, the patient's ECG normalized within one month.
Implications:
- Patients presenting with Aslanger's pattern require urgent evaluation and prompt management, including consideration for emergency coronary angiography and revascularization.
- Timely intervention is critical to mitigate the risk of adverse cardiovascular events in patients with this ECG finding.
Background:
Aslanger's pattern in electrocardiogram (ECG) indicates that patients may have acute inferior myocardial infarction(AMI) with concomitant critical stenoses on other coronary arteries, which needs to be evaluated the timing of revascularization as risk equivalents of ST elevation myocardial infarction(STEMI).
Case Presentation:
The patient was a 62-year-old male with chief complaint of intermittent exertional subxiphoid pain for 20 days from 30th June. One day after the last episode (19th July), the 18-lead electrocardiogram showed ST segment elevation of 0.05-0.1mV in lead III, ST segment depression in leads I, avL, and V2-V6, T wave inversion with positive terminal vector in lead V4-V5, and positive T wave in lead V6, which indicated Aslanger's pattern. With increased Troponin I (0.162ng/mL, 0-0.02), The patient was diagnosed as acute non-ST-segment elevation myocardial infarction (NSTEMI) and admitted to coronary ward on 20th July. The coronary angiography showed 95% stenosis in the distal left main coronary artery (LM) to the ostium of the left anterior descending artery (LAD), 90% stenosis in the proximal segment of the LAD, and 80% stenosis in the middle segment of the LAD, and TIMI blood flow was graded score 2. Three drug-eluting stents were implanted at the lesions. The patient's ECG returned close to normal one month after revascularization.
Conclusion:
We presented an acute coronary syndrome case whose ECG showed with Aslanger's pattern (i.e., isolated ST-segment elevation in lead III, associated ST-segment depression in lead V4-V6 with positive T wave/terminal vector, and greater ST-segment elevation in lead V1 than in lead V2), and was confirmed severe stenosis of the LM and the proximal segment of the LAD via coronary angiography. In clinical practice, especially in the emergency, patients with ECG presenting Aslanger's pattern should be urgently evaluated with prompt treatment, and the timing of emergency coronary angiography and revascularization should be evaluated to avoid adverse outcomes caused by delayed treatment.
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