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Simultaneous Myocardial Infarctions in Dual Coronary Territories Due to a Single Culprit Lesion: A Diagnostic and

Nidhi Singh1, Tushar Agarwal1, Rishika Gupta2

  • 1Department of Cardiology, Sarvodaya Hospital, Greater Noida West, IND.

Cureus
|July 25, 2025
PubMed

Insights

This case study describes a rare instance of myocardial infarction (MI) presenting with simultaneous ECG changes in two coronary artery territories. Prompt percutaneous intervention successfully restored blood flow, leading to rapid recovery.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Interventional Cardiology

Background:

  • Electrocardiographic (ECG) changes in myocardial infarction (MI) typically indicate a specific ischemic territory and culprit artery.
  • Simultaneous ECG changes in territories supplied by two different coronary arteries are rare and pose diagnostic challenges.

Observation:

  • A patient presented with acute chest pain and concurrent hyperacute T-waves in anterior ECG leads (suggestive of left anterior descending artery occlusion) and ST-segment elevations in inferior leads (suggestive of right coronary artery occlusion).

Findings:

  • Coronary angiography revealed a chronic total occlusion of the right coronary artery (RCA) with retrograde filling from the left anterior descending (LAD) artery, alongside an acute thrombotic lesion in the mid-LAD.
  • Emergency percutaneous intervention of the LAD restored perfusion to both coronary territories.

Implications:

  • This case underscores the importance of recognizing atypical ECG presentations in MI.
  • Early revascularization strategies are crucial for managing complex cases with diagnostic dilemmas.
  • Understanding coronary artery anatomy and collateral circulation is vital for successful MI management.

Keywords:
12-lead ecgcoronary angiographyculprit lesionpercutaneous transluminal coronary angioplastyst-elevation myocardial infarction (stemi)

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