A new electrocardiographic pattern suggestive of occlusion myocardial infarction: a report of two cases.
- Authors
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Haifa Bradai
Emergency Care Teaching Centre (CESU) 03, Sahloul, Sousse, Tunisia
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Rabeb Mbarek
Emergency Care Teaching Centre (CESU) 03, Sahloul, Sousse, Tunisia
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Nabil Chebbi
Emergency Care Teaching Centre (CESU) 03, Sahloul, Sousse, Tunisia
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Imen KETATA
AHU urgence Ibn Jazzar Kairouan
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Anis Haj Hssine
Emergency Care Teaching Centre (CESU) 03, Sahloul, Sousse, Tunisia
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Naoufel Chebili
Emergency Care Teaching Centre (CESU) 03, Sahloul, Sousse, Tunisia
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- Keywords:
- Aslanger pattern; STEMI-equivalent; acute coronary occlusion; electrocardiogram; case report.
- Abstract
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Background: Classical teaching assumes that the location of ST-segment elevation (STE) on the electrocardiogram (ECG) reflects the site of myocardial infarction (MI), and current guidelines require STE in two contiguous leads to diagnose ST-elevation MI (STEMI). This framework can miss high-risk occlusive infarctions presenting with atypical, non-contiguous STE. Methods: We retrospectively describe two patients presenting with acute coronary syndrome whose initial 12-lead ECG displayed the Aslanger pattern: isolated STE in lead III, ST-segment depression in leads V4-V6, and STE in V1 greater than in V2. Results: Both patients were diagnosed with a STEMI-equivalent Aslanger pattern and underwent urgent coronary angiography. The first, with known multivessel disease, had critical left anterior descending (LAD) artery stenosis; the second presented in cardiogenic shock with an occlusive thrombus in the right coronary artery. Both were successfully treated with percutaneous coronary intervention. Conclusion: The Aslanger pattern is a high-risk STEMI-equivalent that can be missed under conventional STE criteria. Our cases, including an atypical LAD culprit lesion, support incorporating this pattern into routine ECG interpretation and emergency training to enable timely reperfusion.
- References
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1.Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction. J Am Coll Cardiol. 2018; 72:2231–64.
2.Fiol M, Carrillo A, Cygankiewicz I, Velasco J, Riera M, Bayés-Genis A, et al. A new electrocardiographic algorithm to locate the occlusion in left anterior descending coronary artery. Clin Cardiol. 2009;32: E1–6.
3.Bozbeyoğlu E, Aslanger E, Yıldırımtürk Ö, Şimşek B, Hündür B, Karabay CY, et al. The established electrocardiographic classification of anterior wall myocardial infarction misguides clinicians in terms of infarct location, extent and prognosis. Ann Noninvasive Electrocardiol. 2019;24: e12628
4.Bozbeyoğlu E, Aslanger E, Yıldırımtürk Ö, Şimşek B, Karabay CY, Türer A, et al. An algorithm for the differentiation of the infarct territory in difficult to discern electrocardiograms. J Electrocardiol. 2018; 51:1055–65.
5.Bozbeyoğlu E, Yıldırımtürk Ö, Aslanger E, Şimşek B, Karabay CY, Ozveren O, et al. Is the inferior ST-segment elevation in anterior myocardial infarction reliable in prediction of wrap-around left anterior descending artery occlusion? Anatol J Cardiol. 2019; 21:253–8.
6.Durant E, Singh A. Acute first diagonal artery occlusion: a characteristic pattern of ST-elevation in noncontiguous leads. Am J Emerg Med. 2015; 33:1326. e3–5.
7.Sclarovsky S, Birnbaum Y, Solodky A, Zafrir N, Wurzel M, Rechavia E. Isolated midanterior myocardial infarction: a special electrocardiographic sub-type of acute myocardial infarction consisting of ST-elevation in non-consecutive leads and two different morphologic types of ST-depression. Int J Cardiol. 1994; 46:37–47.
8. Aslanger E, et al. A new electrocardiographic pattern indicating inferior myocardial infarction. J Electrocardiol. 2020; 61:41-46
9.Yildirim ÖT, Canakci ME. The new ECG pattern for inferior myocardial infarction. J Electrocardiol. 2020.
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- Published
- 30-09-2026
- Section
- Case Reports
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