title: A patient with non-ST-segment elevation acute coronary syndrome: Is it possible to predict the culprit coronary artery?
abstract: In acute coronary syndromes without ST-segment elevation (NSTE-ACS), identification of the culprit artery is, most often, not possible. In this case report, we elaborate on the likelihood of different culprit arteries in a patient with NSTE-ACS. While her symptoms were progressing, typical ECG findings of ischemia in the left coronary territories were diminishing. Instead, dynamic T-wave changes in the inferior leads were present and were most likely postischemic and "reischemic." Although the culprit artery could not be identified with certainty by means of these subtle changes, they correlated well with the findings on angiography and the ECG recorded afterward. This case report demonstrates the importance of analyzing ECG and its temporal changes in conjunction with evolving symptoms.
authors.affiliation: Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden. Electronic address: thomas.a.lindow@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lindow
authors.affiliation: Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Pahlm
authors.affiliation: Heart Center, Tampere University Hospital and School of Medicine, University of Tampere, Finland.
authors.forename: Kjell
authors.initials: K
authors.lastname: Nikus
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000465:Algorithms; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis*
keywords: ECG; ST-segment elevation; ischemia