Clinical Vignette

Two cases of acute Anterior STEMI. The importance of knowing the site of occlusion.

The ECGs are:
Case 3a Image Case 3b Image

ECG Description and Analysis

Questions that we must ask:
1. What ECG shows an area of ischemia more extensive?
2. How do I know that the bottom ECG does not correspond to the RCA or LCX occlusion?
3. Where is the occlusion located in both ECGs?

The ECGs are:
Case 3a Image Case 3b Image

Let’s Analyze Case 3

What ECG shows an area of ischemia more extensive?
The top ECG is a typical case of STEMI due to proximal LAD occlusion before the first diagonal and first septal branches.
[Detailed analysis continues with images and explanations.]

Analyze 3 Image — In an acute coronary syndrome with ST-segment elevation in V1-V2 to V4-V6 as the most striking pattern, the occluded artery is the left anterior descending coronary artery (LAD).

Where is the occlusion located in both ECGs?
The figure below shows the algorithm to locate the zone of LAD occlusion in case of STEMI with predominant ST-segment elevation in precordial leads.

Analyze 4 Image — Algorithm to locate the site of occlusion in case of predominant ST-segment elevation in precordial leads (LAD occlusion).

Exercise Based on Case 3

1. Check if ST depression in III + aVF is greater than 2.5 mm in the top ECG.
2. Search the lead with the highest ST elevation on the bottom ECG.

What’s Your Diagnosis?

Acute anterior myocardial infarction before and after the origin of the first diagonal branch.