Abstract
Background
According to guidelines, patients with inferior myocardial infarction only qualify
for emergent reperfusion if they have at least 1 mm of ST elevation in two contiguous
inferior leads. Although this has remained the standard for years, acute coronary
occlusion may occur in patients with nondiagnostic ST elevation. Accordingly, a paradigm
change is instigated, shifting the focus to physiopathology (occlusion myocardial
infarction) rather than ST criteria.
Case Report
A middle-aged man presented to our emergency department with chest pain and subtle
nondiagnostic electrocardiography (ECG) changes in inferior leads. A careful examination
of aVL to detect ST depression in this lead was the key to successfully diagnosing
occlusion myocardial infarction, allowing early revascularization of an occluded right
coronary artery.
Why Should an Emergency Physician Be Aware of This?
Accurate diagnosis of coronary occlusion by means of ECG can be challenging in certain
situations, as acute myocardial ischemia may occur in patients with nondiagnostic
ST elevation, especially in the inferior leads. A thorough examination of aVL searching
for ST depression is essential in these situations.
Keywords
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Article info
Publication history
Published online: December 26, 2022
Accepted:
December 13,
2022
Received in revised form:
October 30,
2022
Received:
September 21,
2022
Identification
Copyright
Published by Elsevier Inc.
