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An Unusual Presentation of a Left Anterior Descending Artery Obstruction, A Deadly Disease

Osvaldo E Duran-Melendez1, Frank Zorrilla-Caballero2, Juan Gonzalez-Sanchez3

  • 1PGY 3 resident at University of Puerto Rico Emergency Medicine Residency.

Puerto Rico Health Sciences Journal
|June 18, 2025
PubMed

Insights

Continuous ST segment monitoring (C-STM) in the emergency department (ED) can detect subtle ischemic changes in acute coronary syndrome (ACS) patients. This case shows C-STM

Area of Science:

  • Cardiology
  • Emergency Medicine

Background:

  • Acute coronary syndrome (ACS) diagnosis can be challenging with non-diagnostic initial ECGs.
  • Continuous ST segment monitoring (C-STM) offers a potential tool for detecting transient ischemic changes.

Observation:

  • A 62-year-old male with diabetes and hypertension presented with resolved chest pain.
  • Initial electrocardiogram (ECG) was non-diagnostic for acute coronary syndrome.

Findings:

  • C-STM identified transient hyperacute T waves and mild ST elevations.
  • These findings prompted further investigation, leading to percutaneous coronary intervention (PCI) for a critical left anterior descending artery lesion.

Implications:

  • C-STM may be valuable for identifying ACS in emergency department settings.
  • This case highlights the importance of continuous monitoring and timely intervention for atypical ACS presentations.
  • Further research is needed to determine which ACS patients benefit most from C-STM.

Keywords:
Acute Coronary Syndrome (ACS)Chest painContinuous ST segment monitoring (C-STM)Left Anterior Descending (LAD) artery obstructionTransient ischemic changes

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