Recognition of Subtle ECG Manifestations of Left Anterior Descending Coronary Artery Occlusion

Hamade et al1 describe a case of a young man with myocardial infarction caused by occlusion of the left anterior descending coronary artery. The first recorded ECG is described as being "without ischemic changes." We suggest, however, that one must consider this ECG as manifesting left anterior descending occlusion until and unless proven otherwise. Left anterior descending occlusion is known to often present with less than 1 mm of ST-segment elevation in the anterior leads2; here, it is approximately 1 mm at the J point relative to the PQ junction.

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