Advertisement

Acute first diagonal artery occlusion: a characteristic pattern of ST elevation in noncontiguous leads

Published:February 07, 2015DOI:https://doi.org/10.1016/j.ajem.2015.02.008
      The most commonly identified site of coronary occlusion is the left anterior descending artery (LAD). [
      • Rentrop K.P.
      • Cohen M.
      • Blanke H.
      • Phillips R.A.
      Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects.
      ] Identification of the site of occlusion by noninvasive means can help predict the size of the infarct and help in guiding interventions (Fig. 1, Fig. 2). Previous studies have demonstrated good correlation between electrocardiographic (ECG) findings and localization of the lesion to the first diagonal branch. Here, we present a case of acute diagonal occlusion with characteristic ECG findings.
      Figure thumbnail gr1
      Fig. 1Prehospital ECG demonstrating ST-elevation in leads 1, v2, and avL and ST-depressions in II, III, and avF.
      Figure thumbnail gr2
      Fig. 2Emergency Department ECG demonstrating ST-elevation in leads 1, v2, and avL and ST-depressions in II, III, and avF.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rentrop K.P.
        • Cohen M.
        • Blanke H.
        • Phillips R.A.
        Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects.
        J Am Coll Cardiol. 1985; 5: 587-592
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • et al.
        Third universal definition of myocardial infarction.
        Circulation. 2012; 126: 2020-2035
        • Dastidar Amardeep
        STEMI equivalent: are we missing the STEMIs?.
        ([Internet]. London: British Cardiovascular Society; [cited 2015 Jan 31] Available from:)
        • Sclarovsky S.
        • Birnbaum Y.
        • Solodky A.
        • Zafrir N.
        • Wurzel M.
        • Rechavia E.
        Isolated mid-anterior 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
        • Birnbaum Y.
        • Hasdai D.
        • Sclarovsky S.
        • Herz I.
        • Strasberg B.
        • Rechavia E.
        Acute myocardial infarction entailing ST-segment elevation in lead aVL: electrocardiographic differentiation among occlusion of the left anterior descending, first diagonal, and first obtuse marginal coronary arteries.
        Am Heart J. 1996; 131: 38-42
        • Szymański F.M.
        • Grabowski M.
        • Filipiak K.J.
        • Karpiński G
        • Małek LA
        • Stolarz P
        • et al.
        Electrocardiographic features and prognosis in acute diagonal or marginal branch occlusion.
        Am J Emerg Med. 2007; 25: 170-173https://doi.org/10.1016/j.ajem.2006.06.014
        • Iwasaki K.
        • Kusachi S.
        • Kita T.
        • Taniguchi G.
        Prediction of isolated first diagonal branch occlusion by 12-lead electrocardiography: ST segment shift in leads I and aVL.
        J Am Coll Cardiol. 1994; 23: 1557-1561
        • Engelen D.J.
        • Gorgels A.P.
        • Cheriex E.C.
        • De Muinck ED
        • Ophuis AJ
        • Dassen WR
        • et al.
        Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction.
        J Am Coll Cardiol. 1999; 34: 389-395