An unusual presentation of left anterior descending artery occlusion: significance of lead aVR and T-wave direction

Acute occlusion of the left anterior descending coronary artery (LAD) is frequently encountered in acute ST-elevation myocardial infarction. Early detection of the clinical entity by the presenting electrocardiogram (ECG) should result in immediate aggressive clinical management. Although the typical ECG pattern of LAD occlusion is ST elevation, also atypical presentations, like ST depression, may occur. We describe a case with an unusual ECG pattern that suggested acute anterior myocardial infarction due to LAD occlusion.