Acute Inferior ST-elevation Myocardial Infarction Arising from Wrap-Around Left Anterior Descending Artery Occlusion

Abstract

BACKGROUND: Acute myocardial infarction (AMI) remains a leading cause to global morbidity and mortality. Inferior MI predominantly stems from the right coronary artery (RCA) in more than 80% of instances, the left circumflex coronary artery (LCx) in fewer than 20% of cases, and infrequently from the left anterior descending artery (LAD) AIMS: This case report aims to highlight a rare occurrence of LAD occlusion initially manifested as inferior MI. CASE: A 56-year-old male presented with typical chest pain lasting for 6 hours. Vital signs were within normal range. Initial electrocardiogram (ECG) revealed ST-segment elevation in inferior leads (II, III, aVF). Laboratory tests indicated elevated troponin levels (>25ng/mL). Coronary angiography identified the culprit lesion as the LAD, which wrapped around the apex. DISCUSSION: While ECG alterations are valuable in identifying thrombosed vessels during AMI, the presence of simultaneous ST elevation in both inferior and anterior leads can hinder clinicians' ability to determine the specific artery affected by the infarction. Our case, depicting a scenario where both the right and left coronary arteries are co-dominant, showed complete occlusion at the mid-distal wrap-around LAD, resulting in ST-elevation observed in both inferior and anterior leads. CONCLUSION: The existence of inferior ST-segment elevation alongside alterations in anterior leads could imply occlusion of the wrapped LAD.