title: Normal electrocardiogram in a patient with an acute proximal left anterior descending coronary artery occlusion.
abstract: We report the case of an acute proximal occlusion of the left anterior descending (LAD) coronary artery, possibly due to exercise-induced dissection, in a previously well 43-year-old man with persistently normal electrocardiograms (ECG) and cardiac enzymes throughout his hospitalisation. In LAD lesions, ECG repolarisation abnormalities usually reflect the underlying acute coronary event; however, despite negative cardiac biomarkers, a typical cardiac history of chest pain prompted coronary catheterisation. The patient underwent percutaneous coronary intervention to the LAD artery with a dissection flap clearly seen. Successful deployment of drug-eluting stents restored coronary perfusion without residual left ventricular damage. The patient recovered well, and was discharged home on secondary preventative therapies. Our case emphasises that a normal ECG and negative cardiac biomarkers should not preclude further investigations in a patient presenting with a classical ischaemic history, as appropriate early invasive management can prove life-saving.
authors.affiliation: Department of Cardiology, Watford General Hospital, Watford, Hertfordshire, UK. nikunjravshah@hotmail.com
authors.forename: Nikunj R
authors.initials: NR
authors.lastname: Shah
authors.forename: Mike
authors.initials: M
authors.lastname: Van der Watt
mesh_terms: D000208:Acute Disease; D000328:Adult; D054059:Coronary Occlusion / Q000503:physiopathology*; D004562:Electrocardiography; D006801:Humans; D008297:Male; D012016:Reference Values