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Aslanger Pattern as a Manifestation of Inferior STEMI in Multivessel Coronary Artery Disease
Diego Ortiz-Mendiguren1, Giovanni Rivera-Colón1, Andrew Engel-Rodríguez1
1Division of Cardiology, Veterans Affairs Medical Center, San Juan, Puerto Rico.
Insights
The Aslanger pattern, a subtle ECG finding, can mask inferior occlusion myocardial infarction in patients with multivessel coronary artery disease. Recognizing this pattern is crucial for timely diagnosis and treatment.
Area of Science:
- Cardiology
- Electrocardiography
Background:
- The Aslanger pattern is an electrocardiographic finding associated with inferior occlusion myocardial infarction.
- It may not meet traditional ST-segment elevation criteria, especially in multivessel coronary artery disease.
Background:
The Aslanger pattern is a subtle electrocardiographic manifestation of inferior occlusion myocardial infarction that may not meet traditional ST-segment elevation criteria, particularly in the setting of multivessel coronary artery disease.
Case Summary:
A 79-year-old man with known multivessel coronary artery disease presented with intermittent chest pain and was admitted for medical management of suspected unstable angina. Initial electrocardiogram (ECG) showed no acute ischemic changes. During hospitalization, he developed recurrent chest pain with subtle ECG findings consistent with the Aslanger pattern, which was not recognized at the time. Symptoms transiently resolved; however, on the following day, the ECG evolved to demonstrate overt inferior ST-segment elevation myocardial infarction. Emergent coronary angiography revealed left main and 3-vessel coronary artery disease with late stent thrombosis of the mid right coronary artery.
Discussion:
This case illustrates how limited inferior wall injury combined with diffuse subendocardial ischemia in multivessel coronary artery disease can alter ST-segment vectors, masking an inferior occlusion myocardial infarction and delaying recognition.
Take-Home Message:
Early recognition of the Aslanger pattern may facilitate timely diagnosis of inferior occlusion myocardial infarction and guide appropriate revascularization strategies in patients with multivessel coronary artery disease.
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