ST-Segment Elevation in Lead aVR With Global ST-Segment Depression: Never Neglect Left Main Coronary Artery (LMCA) Occlusion

An electrocardiographic pattern consisting of elevated ST segment in lead aVR with global ST-segment depression in multi-leads indicates circumferential subendocardial ischaemia due to mismatch of oxygen supply and demand. This finding of an echocardiogram is strongly suggestive of occlusion of proximal part of left anterior descending part of coronary artery. We describe a patient who presented to us with complaint of chest pain and had ST-segment elevation in lead aVR and global ST-segment depression in multi-leads and was suspected to have occlusion in left anterior descending artery. Patient was taken for early coronary angiography and angioplasty then. It was found that patient had occlusion in proximal part of of left anterior descending part only. Hence, early recognition of the condition and its prognosis can help preventing complications.