Acute Ramus Intermedius Occlusion Presenting as the South African Flag Sign on Electrocardiogram
Dya P Andryan1, Raisa A Manan2, Cynthia Parameswari3
1Cardiology, Umar Wirahadikusumah Regional General Hospital, Sumedang, IDN.
Cureus
|October 27, 2025
Summary
Occlusion of the ramus intermedius artery can cause acute coronary syndrome, mimicking other heart conditions. Recognizing atypical ECG patterns like the "South African flag sign" is crucial for timely diagnosis and treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Electrocardiography
Background:
- The ramus intermedius (RI) artery is an uncommon source of acute coronary syndrome (ACS).
- RI occlusion can present atypically, complicating diagnosis and mimicking other coronary artery occlusions.
- The
- South African flag sign
- on electrocardiogram (ECG) is typically associated with left circumflex artery (LCx) or first diagonal branch (D1) occlusion.
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