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Distinctive electrocardiographic pattern in acute myocardial infarction.

János Tomcsányi1, Előd Papp1, Béla Bózsik1

  • 1Buda Hospital of the Hospitaller Order of St John of God, Department of Cardiology, Budapest, Hungary.

Journal of Electrocardiology
|February 28, 2026
PubMed
Summary

We describe a unique ST-elevation myocardial infarction (STEMI) case where anterior chest leads mimicked limb leads. This finding relates to the Littmann concept of precordial lead projection onto the frontal plane.

Keywords:
Left septal fascicular blockLittmann conceptSTEMI

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Area of Science:

  • Cardiology
  • Electrocardiography
  • Medical Diagnostics

Background:

  • Antero-inferior ST-elevation myocardial infarction (STEMI) typically suggests proximal coronary artery occlusion.
  • Common causes include occlusion of the right coronary artery (RCA), wrap-around left anterior descending (LAD) artery, or multivessel disease.
  • Standard electrocardiogram (ECG) interpretation relies on specific lead placements and their corresponding cardiac electrical activity planes.

Purpose of the Study:

  • To present an unusual STEMI case with a distinct QRS and ST-segment pattern.
  • To explain this unique pattern using the Littmann concept of electrocardiographic lead projection.

Main Methods:

  • Case report of a patient presenting with typical chest pain and STEMI.
  • Analysis of the 12-lead electrocardiogram (ECG), focusing on anterior chest leads (V1-V3) and limb leads (aVR, aVL, aVF).
  • Application of the Littmann concept to interpret the observed ECG findings.

Main Results:

  • The anterior chest leads (V1, V2, V3) exhibited patterns mimicking their augmented unipolar limb lead counterparts (aVR, aVL, aVF).
  • This mimicry was observed in the context of STEMI, suggesting an atypical presentation.
  • The Littmann concept provided a theoretical framework, explaining how precordial leads V1-V3 possess significant frontal plane projection.

Conclusions:

  • The Littmann concept effectively explains unique ECG patterns where precordial leads reflect frontal plane activity.
  • This case highlights the importance of considering advanced electrocardiographic principles for diagnosing complex STEMI presentations.
  • Understanding lead vector projections is crucial for accurate interpretation of myocardial infarction, even in atypical scenarios.