Acute Inferior ST-elevation Myocardial Infarction Arising from Wrap-Around Left Anterior Descending Artery Occlusion

Authors

  • Daniel Nugraha Department of Cardiology and Vascular, Faculty of Medicine Diponegoro University/ Kariadi Hospital Semarang, Indonesia
  • David Jonathan Pesireron Department of Cardiology and Vascular, Faculty of Medicine Diponegoro University/ Kariadi Hospital Semarang, Indonesia
  • Muhamad Sofan Dhani Department of Cardiology and Vascular, Faculty of Medicine Diponegoro University/ Kariadi Hospital Semarang, Indonesia
  • Ardi Yudha Department of Cardiology and Vascular, Faculty of Medicine Diponegoro University/ Kariadi Hospital Semarang, Indonesia
  • Safir Department of Cardiology and Vascular, Faculty of Medicine Diponegoro University/ Kariadi Hospital Semarang, Indonesia

DOI:

https://doi.org/10.36408/mhjcm.v11i2.1114

Keywords:

Inferior ST elevation, Total occlusion, Acute myocardial infarction, Wrap around LAD

Abstract

BACKGROUND: Acute myocardial infarction (AMI) remains a leading cause to global morbidity and mortality. Inferior MI predominantly stems from the right coronary artery (RCA) in more than 80% of instances, the left circumflex coronary artery (LCx) in fewer than 20% of cases, and infrequently from the left anterior descending artery (LAD)

AIMS: This case report aims to highlight a rare occurrence of LAD occlusion initially manifested as inferior MI.

CASE: A 56-year-old male presented with typical chest pain lasting for 6 hours. Vital signs were within normal range. Initial electrocardiogram (ECG) revealed ST-segment elevation in inferior leads (II, III, aVF). Laboratory tests indicated elevated troponin levels (>25ng/mL). Coronary angiography identified the culprit lesion as the LAD, which wrapped around the apex.

DISCUSSION: While ECG alterations are valuable in identifying thrombosed vessels during AMI, the presence of simultaneous ST elevation in both inferior and anterior leads can hinder clinicians' ability to determine the specific artery affected by the infarction. Our case, depicting a scenario where both the right and left coronary arteries are co-dominant, showed complete occlusion at the mid-distal wrap-around LAD, resulting in ST-elevation observed in both inferior and anterior leads.

CONCLUSION: The existence of inferior ST-segment elevation alongside alterations in anterior leads could imply occlusion of the wrapped LAD.

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Author Biographies

David Jonathan Pesireron, Department of Cardiology and Vascular, Faculty of Medicine Diponegoro University/ Kariadi Hospital Semarang

Department of Cardiology and Vascular, Medical Faculty of Diponegoro University/Central General Hospital of Kariadi Semarang, Indonesia

 

Muhamad Sofan Dhani, Department of Cardiology and Vascular, Faculty of Medicine Diponegoro University/ Kariadi Hospital Semarang

Department of Cardiology and Vascular, Medical Faculty of Diponegoro University/Central General Hospital of Kariadi Semarang, Indonesia

Ardi Yudha, Department of Cardiology and Vascular, Faculty of Medicine Diponegoro University/ Kariadi Hospital Semarang

Department of Cardiology and Vascular, Medical Faculty of Diponegoro University/Central General Hospital of Kariadi Semarang, Indonesia

Safir, Department of Cardiology and Vascular, Faculty of Medicine Diponegoro University/ Kariadi Hospital Semarang

Department of Cardiology and Vascular, Medical Faculty of Diponegoro University/Central General Hospital of Kariadi Semarang, Indonesia

References

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Additional Files

Published

2024-07-31

How to Cite

1.
Nugraha D, Pesireron DJ, Dhani MS, Yudha A, Safir S. Acute Inferior ST-elevation Myocardial Infarction Arising from Wrap-Around Left Anterior Descending Artery Occlusion . Medica Hospitalia J. Clin. Med. [Internet]. 2024 Jul. 31 [cited 2024 Dec. 11];11(2):236-9. Available from: http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/1114

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