Key result
Urgent PCI successfully resolves subtotal LAD occlusion presenting with malignant shark-fin ECG pattern.
Why the study?
The shark-fin morphology on ECG is a rare but malignant STEMI pattern associated with profound transmural ischemia and high risk of cardiogenic shock and ventricular fibrillation.
Case Report (n=1)
Prompt recognition of the rare 'shark-fin' ECG morphology is critical, as it signifies profound transmural ischemia mimicking wide-complex arrhythmias that requires immediate reperfusion to prevent cardiogenic shock or malignant ventricular arrhythmias.
May support urgent PCI for shark-fin ECG; leaves open generalizability beyond this single case.
CASE SUMMARY: The shark-fin morphology on electrocardiogram (ECG) represents a malignant ST-segment elevation myocardial infarction pattern associated with profound transmural ischemia. A 49-year-old man with episodic chest pain had an initially nondiagnostic ECG. With recurrent symptoms and rising troponins, repeat ECG showed ventricular bigeminy and a giant triangular QRS-ST-T waveform in the anterolateral leads. Angiography revealed subtotal proximal left anterior descending artery occlusion, which was managed urgently with percutaneous coronary intervention. TAKE-HOME MESSAGES: The shark-fin morphology is a rare but malignant ST-segment elevation myocardial infarction pattern that may mimic wide-complex ECG abnormalities. Prompt recognition should trigger immediate reperfusion and vigilance for cardiogenic shock and ventricular fibrillation.
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Radhakrishna et al. (2026) conducted a case report in ST-segment elevation myocardial infarction (n=1). Percutaneous coronary intervention was evaluated. Urgent percutaneous coronary intervention successfully treated subtotal occlusion of the left anterior descending artery in a patient presenting with the malignant 'shark-fin' electrocardiogram pattern.
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