Acute myocardial infarction with significant left main coronary artery stenosis, significant 3-vessel coronary artery disease and elevated troponin-I at admission.

Abstract	Exercise-induced ST-segment elevation in lead aVR accompanied by ST-segment elevation in lead V1 might be a specific finding of left main coronary artery (LMCA) stenosis. Lead aVR and lead v1 ST segment elevation has been reported, during an attack of chest pain, in patients with LMCA disease with ST segment depression in leads V3, V4 and V5 (with maximal depression in V4). ST-segment elevation in lead aVR in patients with angina at rest can be related to transmural ischemia of the basal part of the interventricular septum, frequently due to LMCA or multivessel coronary disease too. 3-vessel coronary artery disease (CAD) and LMCA disease show a frequent combination of leads with abnormal ST segments during chest pain with ST-segment depression in leads I II V4-V6, and ST-segment elevation in lead aVR. When ST-segment status in lead aVR combines with troponin T, ST-segment elevation in lead aVR and positive troponin T on admission are useful predictors of LMCA or 3-vessel CAD. We present a case of acute myocardial infarction with significant left main coronary artery stenosis, significant 3-vessel coronary artery disease and elevated troponin I at admission in an 83-year-old Italian woman. Also this case focuses attention on the importance of the recognition of the patterns suspected for LMCA and/or 3-vessel coronary disease.
Authors	Salvatore Patanè, Filippo Marte, Mauro Sturiale, Giuseppe Dattilo
Journal	International journal of cardiology (Int J Cardiol) Vol. 153 Issue 1 Pg. e1-2 (Nov 17 2011) ISSN: 1874-1754 [Electronic] Netherlands
PMID	19356809 (Publication Type: Case Reports, Letter)
Copyright	Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.
Chemical References	Troponin I
Topics	Aged, 80 and over Coronary Artery Disease (blood, complications, diagnosis) Coronary Stenosis (blood, complications, diagnosis) Female Humans Myocardial Infarction (blood, complications, diagnosis) Patient Admission Troponin I (blood)

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