A new electrocardiographic pattern suggestive of occlusion myocardial infarction: a report of two cases.

Abstract

Background: Classical teaching assumes that the location of ST-segment elevation (STE) on the electrocardiogram (ECG) reflects the site of myocardial infarction (MI), and current guidelines require STE in two contiguous leads to diagnose ST-elevation MI (STEMI). This framework can miss high-risk occlusive infarctions presenting with atypical, non-contiguous STE. Methods: We retrospectively describe two patients presenting with acute coronary syndrome whose initial 12-lead ECG displayed the Aslanger pattern: isolated STE in lead III, ST-segment depression in leads V4-V6, and STE in V1 greater than in V2. Results: Both patients were diagnosed with a STEMI-equivalent Aslanger pattern and underwent urgent coronary angiography. The first, with known multivessel disease, had critical left anterior descending (LAD) artery stenosis; the second presented in cardiogenic shock with an occlusive thrombus in the right coronary artery. Both were successfully treated with percutaneous coronary intervention. Conclusion: The Aslanger pattern is a high-risk STEMI-equivalent that can be missed under conventional STE criteria. Our cases, including an atypical LAD culprit lesion, support incorporating this pattern into routine ECG interpretation and emergency training to enable timely reperfusion.