Electrocardiographic Manifestions of
Proximal Left Anterior Descending
Artery Occlusion
Bernard M. Karnath, MD, John C. Champion, MD,
and Masood Ahmad, MD
Abstract: We report the case of a 51-year-old woman who presents with a
2-week history of episodes of pressure like chest pain. The initial electrocar-
diogram was not indicative of myocardial ischemia or infarction and the
cardiac enzymes remained normal during the initial hospital day. However, the
precordial T waves inverted and progressively deepened on the second hospital
day and the patient underwent cardiac catheterization with percutaneous
coronary angioplasty and stent placement of the left anterior descending
coronary artery with good results. The postprocedure electrocardiogram
showed complete resolution of the inverted precordial T waves. The develop-
ment of new T-wave inversions in the precordial leads of patients presenting
with unstable angina is predictive of significant stenosis of the left anterior
descending coronary artery. This subgroup of patients has a poor prognosis if
medical therapy alone is instituted. Early cardiac catheterization and revascu-
larization is recommended for these patients. Evidence has shown that 75%
patients with these electrocardiogram changes who are not revascularized
developed extensive anterior wall infarction within a few weeks. Key words:
Anterior ischemia, Wellen’s Syndrome, T-wave inversions.
The patient is a 51-year-old woman who presents
with a 2-week history of episodes of pressure like
chest pain. An electrocardiogram (ECG) was ob-
tained in the emergency department and reveals
poor R-wave progression and an indeterminate axis
(Fig. 1). The patient was admitted for observation
with serial cardiac enzymes and ECGs. The cardiac
enzymes remained normal. However, T-wave in-
versions became quite evident in the precordial
leads on the second hospital day (Fig. 2). An
echocardiogram revealed a left ventricular (LV)
ejection fraction was 50%. The patient subse-
quently underwent cardiac catheterization.
Discussion
Chest pain is a common presenting complaint in
emergency departments. Work up of acute chest
pain often includes serial cardiac enzymes and an
ECG to rule out ischemic heart disease as an etiol-
ogy. The ECG is the most commonly used diagnos-
From the Department of Internal Medicine, The University of Texas
Medical Branch at Galveston, TX.
Reprint requests: Bernard M. Karnath, MD, Department of
Internal Medicine, The University of Texas Medical Branch at
Galveston, 301 University Blvd, Galveston, TX 77555-0566.
© 2003 Elsevier Inc. All rights reserved.
0022-0736/03/3602-0014$30.00/0
doi:10.1054/jelc.2003.50024
Journal of Electrocardiology Vol. 36 No. 2 2003
173