Key result
Subtotal LMCA occlusion presents atypically with aVR and aVL elevation and bifascicular block.
Why the study?
In acute LMCA occlusion, promptly recognizing atypical electrocardiogram changes is important to hasten revascularization therapy without delays.
Case Report (n=1)
No
Highlights a rare and easily misdiagnosed atypical ECG manifestation (ST-elevation in aVR/aVL with bifascicular block) of critical subtotal LMCA occlusion, emphasizing the need for prompt recognition.
Clinicians should consider LMCA occlusion with this atypical ECG; single case leaves open diagnostic validation in larger cohorts.
Acute occlusion of the left main coronary artery (LMCA) is one of the most severe forms of acute coronary syndrome. Besides the typical electrocardiogram changes, it is important to promptly recognize atypical changes and hasten revascularization therapy without delays. By analyzing specific cases, this work revealed that ST-segment elevation in aVR and aVL leads, accompanied by newly developed bifascicular block that cannot be ruled out as pathological, but without ST-segment deviation in the chest leads, highly indicates a rare electrocardiographic manifestation of complete occlusion of the LMCA. On the other hand, subtotal occlusion represents an even rarer scenario.
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Ni et al. (2025) conducted a case report in Subtotal occlusion of the left main coronary artery presenting with atypical ECG changes (n=1). Subtotal occlusion of the left main coronary artery (exposure) / Drug-eluting stents (intervention) was evaluated. Subtotal occlusion of the left main coronary artery was identified as the cause of an atypical electrocardiogram presentation featuring ST-segment elevation in leads aVR and aVL with bifascicular block.
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