Myocardial infarction due to left main coronary artery total occlusion: A unique electrocardiographic presentation

Iosif Xenogiannis; Fotios Kolokathis; Dimitrios Alexopoulos; Loukianos S Rallidis

doi:10.1016/j.jelectrocard.2022.11.002

Myocardial infarction due to left main coronary artery total occlusion: A unique electrocardiographic presentation

J Electrocardiol. 2023 Jan-Feb:76:26-31. doi: 10.1016/j.jelectrocard.2022.11.002. Epub 2022 Nov 9.

Authors

Iosif Xenogiannis¹, Fotios Kolokathis², Dimitrios Alexopoulos², Loukianos S Rallidis²

Affiliations

¹ Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Greece. Electronic address: [email protected].
² Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Greece.

PMID: 36399954
DOI: 10.1016/j.jelectrocard.2022.11.002

Abstract

Left main coronary artery (LMCA) total occlusion typically presents as anterolateral ST-segment myocardial infarction with or without right bundle branch block with left anterior fascicular block, and ST-segment elevation in aVR. On the contrary to the previously described electrocardiographic pattern we describe a distinct electrocardiographic presentation in a patient with total LMCA occlusion characterized by the presence of complete LBBB co-existing with upsloping ST-segment depression in precordial leads leading to symmetrical, tall, positive T waves, the so called de Winter's sign.

Keywords: Left bundle branch block; Left main; Myocardial infarction; ST-segment elevation; aVR lead; de Winter's sign.

MeSH terms

Anterior Wall Myocardial Infarction* / complications
Bundle-Branch Block / complications
Bundle-Branch Block / diagnosis
Coronary Angiography
Coronary Occlusion* / complications
Coronary Occlusion* / diagnosis
Coronary Vessels
Electrocardiography
Humans
Myocardial Infarction* / complications
Myocardial Infarction* / diagnosis