# Silent but Deadly: A Case of Obtuse Marginal Artery Occlusion

## TL;DR

A rare case of a deadly heart artery blockage highlights the difficulty in diagnosing obtuse marginal artery occlusions due to subtle symptoms and normal EKGs.

## Contribution

This case report highlights the diagnostic challenges of obtuse marginal artery occlusions and emphasizes the need for high clinical suspicion.

## Key findings

- A 57-year-old female with atypical EKG changes suffered cardiac arrest due to a fully blocked obtuse marginal artery.
- The absence of typical EKG abnormalities delayed diagnosis despite the severity of the occlusion.
- Successful treatment was achieved through thrombectomy and stent placement after coronary angiography.

## Abstract

The obtuse marginal artery (OMA) is a key branch of the left circumflex coronary artery, supplying blood to the lateral wall of the left ventricle. OMA occlusions can result in myocardial ischemia and serious cardiac events, often presenting with subtle or atypical electrocardiogram (EKG) changes, unlike the more pronounced alterations observed with left anterior descending artery occlusions. This case report discusses a 57-year-old female presenting with chest pain and shortness of breath, indicative of acute coronary syndrome. The patient's initial EKG showed occasional premature ventricular contractions (PVCs), T-wave flattening in aVL, and 1 mm ST elevation in V6, but otherwise, it was normal appearing. Despite not having typical EKG abnormalities, the patient suffered a cardiac arrest. Coronary angiography confirmed 100% stenosis of the first OMA branch, which was successfully treated with aspiration thrombectomy and stent placement. The patient did not have collateral coronary vessels, and therefore, did not have a role in making the patient's EKGs difficult to interpret. This case emphasizes the challenges posed by OMA occlusions, underscoring the necessity for a high index of suspicion during the early stages of a patient’s presentation for prompt diagnosis and treatment.