Upsloping ST depression: Is it acute ischemia?

Ann Noninvasive Electrocardiol. 2019 May;24(3):e12607. doi: 10.1111/anec.12607. Epub 2018 Nov 2.

Abstract

We describe a patient with acute coronary syndrome, presenting with upsloping ST depression in leads I, II, V3-V6 and ST elevation in lead aVR. Coronary angiography revealed spontaneous dissection in a big, dominant left circumflex artery. No other lesions identified. During stenting of the dissection site, the distal left circumflex, supplying a large posterior descending artery was occluded, resulting in ST elevation myocardial infarction with ST elevation in lead III and aVF, but not II. This pattern is considered to represent right coronary artery infarction, rather than left circumflex infarction.

Keywords: ST depression; aVR; acute coronary syndrome; coronary artery dissection; electrocardiogram.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / diagnostic imaging*
  • Acute Coronary Syndrome / therapy
  • Cardiac Catheterization / methods
  • Chest Pain / diagnosis
  • Chest Pain / etiology
  • Coronary Angiography / methods*
  • Electrocardiography / methods*
  • Emergency Service, Hospital
  • Humans
  • Male
  • Middle Aged
  • Multimorbidity
  • Percutaneous Coronary Intervention / methods*
  • Prognosis
  • ST Elevation Myocardial Infarction / diagnostic imaging*
  • ST Elevation Myocardial Infarction / therapy
  • Stents
  • Treatment Outcome