Electrocardiographic findings of acute total occlusion associated with a sub-occlusion involving the left anterior descending and the right coronary artery

Background The ECG characteristics of simultaneous acute occlusion/sub-occlusion of two coronary arteries involving the left anterior descending (LAD) and right (RCA) coronary artery have been rarely described in the literature. Methods We present two patient cases, where one of the arteries was totally occluded and the other one had a sub-occlusion with severely limited flow to demonstrate the ECG characteristics of this severe presentation of acute coronary syndrome. Results Two ECG patterns suggested simultaneous occlusions of the RCA and LAD. One pattern was ST-segment elevation (STE) in lead III higher than in lead II with concomitant STE in leads V3-V4. The other pattern was STE in lead III higher than in lead II with the concomitant Dressler - de Winter ECG pattern in leads V2-V4. Conclusions We present two ECG presentations of simultaneous RCA and LAD occlusion/sub-occlusion. We consider these ECG features as high-risk markers in acute ST-elevation myocardial infarction.