Acute Coronary Syndromes Presenting with Transient Diffuse ST Segment Depression and ST Segment Elevation in Lead aVR not Caused by “Acute Left Main Coronary Artery Occlusion”: Description of Two Cases

Authors


Address for correspondence: Yochai Birnbaum, M.D., Professor of Medicine, One Baylor Plaza MS: BCM620, Houston, Texas 77030. Fax: 713-798-0270; E-mail: ybirnbau@bcm.edu

Abstract

Background

Diffuse ST-segment depression in the inferior + anterolateral leads with ST-segment elevation in lead aVR has been described as characteristic of diffuse circumferential subendocardial ischemia caused by acute subtotal occlusion of the left main coronary artery.

Methods

Here we describe two patients admitted for acute neurological disorders who developed transient diffuse ST-segment depression in the inferior + anterolateral leads with ST-segment elevation in lead aVR, associated with elevation of cardiac troponin-I.

Results

In both cases subsequent coronary angiography did not show significant left main stenosis or “left main equivalent” narrowings.

Conclusions

As both patients had acute neurological disorders, a possible association between the two conditions is discussed.

Ancillary