Inferior ST-segment elevation during anterior wall acute myocardial infarction (AMI) due to LAD coronary artery occlusion is uncommon. Interestingly, the culprit lesion in these coronary events was the same segment, proximal LAD. 2), his ECG at four days after primary PCI showed precordial ST elevation ( Fig. Although his ECG on admission showed ST-segment elevation in the inferior leads and ST-segment depression in the V2–V4 leads ( Fig. We report for the first time that coronary artery occlusion at the same segment in a patient showed different ECG changes. These unusual ST-segment changes might be associated with a weaker anterior ischemia due to collaterals and a strong inferior ischemia due to wrapped LAD artery. Emergent CAG showed a complete occlusion of the proximal LAD without collaterals, but his ECG showed precordial ST elevation that was different from ST changes seen on admission. His electrocardiogram (ECG) showed precordial ST elevation, suggesting an involvement of the LAD. Although he underwent primary percutaneous coronary intervention (PCI), he had chest pain at four days after primary PCI. However, coronary angiography (CAG) showed a complete occlusion of the proximal left anterior descending (LAD) coronary artery and collaterals from the left circumflex coronary artery and the RCA. We report a case of acute myocardial infarction caused by left anterior descending artery occlusion presenting as ST elevation in the inferior leads and ST depression in the precordial leads, suggesting an involvement of the right coronary artery (RCA).
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