Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Jul-Sep;8(3):184-186.
doi: 10.4103/ijabmr.IJABMR_365_16.

Combined ST Elevation in a Case of Acute Myocardial Infarction: How to Identify the Infarct-related Artery?

Kavitha Balasubramanian  1 , Balasubramanian Ramachandran  1 , Anandaraja Subramanian  2 , Kandan Balamurugesan  1
Affiliations
Case Reports

Combined ST Elevation in a Case of Acute Myocardial Infarction: How to Identify the Infarct-related Artery?

Kavitha Balasubramanian et al. Int J Appl Basic Med Res. 2018 Jul-Sep.

Abstract

Combined ST elevation in anterior and inferior ECG leads in acute myocardial infarction is not a rarity. It is both interesting and challenging to indentify the infarct related culprit artery. We report the case of a middle aged male with acute myocardial infarction whose admission ECG shows ST elevation in lead II, III, aVF as well as from V1-V3. 90% of such cases are due to single vessel occlusion - majority due to proximal RCA occlusion and the remaining due to mid to distal LAD occlusion. ECG features to differentiate between these two vascular occlusions are discussed. In this case at hand, lead III ST elevation of 2.5 mm and V2/V3≥ 1 indicates proximal RCA as the IRA and the same has been confirmed by pre-discharge coronary angiogram .

Keywords: Distal left anterior descending occlusion; ST elevation; infarct-related artery; proximal artery occlusion.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Admission electrocardiogram showing combined ST elevation in II, III, and aVF as well as in V1, V2, and V3
Figure 2
Figure 2
Right-sided V leads done at admission shows 1-mm ST elevation with biphasic T-wave suggestive of right ventricular infarction
Figure 3
Figure 3
Postthrombolysis electrocardiogram showing good resolution of ST elevation in II, III, and aVF and almost isoelectric ST in V1, V2, and V3
Figure 4
Figure 4
A still from the CAG showing 90% occlusion of the proximal RCA (white arrow)
Figure 5
Figure 5
A still from the CAG showing minimal narrowing of the mid LAD (white arrow)
See this image and copyright information in PMC

References

    1. Sadanandan S, Hochman JS, Kolodziej A, Criger DA, Ross A, Selvester R, et al. Clinical and angiographic characteristics of patients with combined anterior and inferior ST-segment elevation on the initial electrocardiogram during acute myocardial infarction. Am Heart J. 2003;146:653–61. - PubMed
    1. Jim MH, Chan AO, Tang MO, Siu CW, Lee SW, Lau CP, et al. Angiographic and clinical implications of combined ST-segment elevation in anterior and inferior leads in acute myocardial infarction. Clin Cardiol. 2009;32:21–7. - PMC - PubMed
    1. Alzand BS, Gorgels AP. Combined anterior and inferior ST-segment elevation electrocardiographic differentiation between right coronary artery occlusion with predominant right ventricular infarction and distal left anterior descending branch occlusion. J Electrocardiol. 2011;44:383–8. - PubMed
    1. Jim MH, Chan AO, Tang MO, Siu CW, Lee SW, Lau CP, et al. Angiographic and clinical implications of combined ST-segment elevation in anterior and inferior leads in acute myocardial infarction. Clin Cardiol. 2009;32:21–7. - PMC - PubMed
    1. Almansori M, Armstrong P, Fu Y, Kaul P. Electrocardiographic identification of the culprit coronary artery in inferior wall ST elevation myocardial infarction. Can J Cardiol. 2010;26:293–6. - PMC - PubMed

Publication types