The painless ST-elevation myocardial infarction equivalent: a case report

TL;DR

A 61-year-old patient with chest pain had ECG findings that suggested a STEMI equivalent, leading to the discovery of two-vessel coronary disease.

Contribution

Highlights the importance of recognizing STEMI equivalents and the OMI/non-OMI paradigm in diagnosing coronary disease.

Findings

Biphasic T waves and Wellens criteria suggested a STEMI equivalent despite no ST-elevation.

Coronary angiography revealed a two-vessel coronary disease requiring intervention.

The case emphasizes the need to consider non-occlusion infarction ECG abnormalities in chest pain evaluation.

Abstract

This report presents the case of a 61-year-old patient who experienced sporadically occurring episodes of chest pain lasting approximately 15 minutes. The initial electrocardiogram (ECG) showed unspecific repolarization disturbances but no ST-elevation indicative of ST-elevation myocardial infarction (STEMI). However, upon closer examination, biphasic T waves were detected, suggestive of specific repolarization abnormalities. The conventional Wellens criteria were met, possibly indicating an etiopathogenetic correlation with the patient's complaints. Subsequent coronary angiography revealed a functional occlusion of the middle segment of the left anterior descending artery, which was treated by percutaneous transluminal coronary angioplasty/drug eluting stent. It also revealed a severely stenosed distal circumflex artery, indicating a two-vessel coronary disease. If we had used only conventional STEMI criteria, this patient would have certainly been missed. Therefore, when evaluating patients presenting with chest pain, it is imperative to consider non-occlusion infarction ECG abnormalities, known as STEMI equivalents. This case, moreover, highlights the importance of the non-officially proposed occlusion myocardial infarction (OMI)/non-OMI paradigm instead of the old STEMI/non-STEMI dichotomy.

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