Normal electrocardiogram and imaging in a young patient with acute left anterior descending coronary artery occlusion : an unusual case report

Normal electrocardiogram and imaging in a young patient with acute left anterior descending coronary artery occlusion : an unusual case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Normal electrocardiogram and imaging in a young patient with acute left anterior descending coronary artery occlusion : an unusual case report Mehdi Ayoub LAAROUSSI, Nabil Laktib, Mohammed Tribak, Achraf El Haidoudi, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6635377/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Acute occlusion of the left anterior descending coronary artery typically presents with significant electrocardiogram abnormalities and positive cardiac biomarkers, indicative of myocardial ischemia. However, the absence of these findings can obscure diagnosis, particularly in young patients with no significant prior medical history. Objective: To highlight the diagnostic challenge posed by acute anterior myocardial infarction presenting with a completely normal electrocardiogram and imaging findings in a young adult, and to emphasize the importance of maintaining clinical suspicion despite reassuring non-invasive assessments. Case : We report the case of a 34-year-old north African man, previously healthy, who presented with typical chest pain suggestive of myocardial ischemia. Despite multiple normal electrocardiograms, slightly elevated cardiac biomarkers, and normal cardiac imaging, the patient's clinical presentation prompted further evaluation. Coronary catheterization revealed an acute occlusion of the left anterior descending artery, likely related to hypercholesterolemia. The patient underwent successful percutaneous coronary intervention with good outcomes. Conclusion: A normal ECG in the context of clinical symptoms consistent with acute coronary syndromes should not lull the clinician into proceeding with an initially conservative approach as normal electrocardiogram do not rule out severe coronary artery occlusion. Cardiac & Cardiovascular Systems acute coronary syndrome normal electrocardiogram normal imaging coronary occlusion Figures Figure 1 Figure 2 Figure 3 Background We report the case of a young male with an acute occluded proximal left anterior descending (LAD) coronary artery, without ischemic changes on initial or subsequent electrocardiogram (ECG) or cardiac imaging abnormalities and discuss the different mechanisms involved in those misleading findings. Standard ECG is the most important diagnostic tool in patients with suspected acute coronary syndrome 1 .It is an easily accessible and rapid diagnostic tool in patients presenting to hospital with acute chest pain. In acute coronary syndromes, ischemic ECG changes depends on the ECG timing, the position of the culprit vessel territory from ECG leads, the leads arrangement used and the myocardium mass involved. 2 Case presentation We report the case of a 34-year-old north African male with a newly discovered hypercholesterolemia as cardiovascular risk factor who presented to the emergency room, 48 hours prior to admission, with a brief acute chest pain (< 15 min), radiating to the left upper limb. He had already been complaining of Canadian Cardiovascular Society (CCS) stage 2 angina for 1 month, neglected by the patient. The patient denied any use of illicit drugs (cannabis, cocaine, etc…). The physical examination showed a conscious patient with no chest pain, with normal blood pressure, heart rate and no sign of acute heart failure or other complications.12-lead ECG (Fig. 1) showed no features suggesting acute ischemia .The ECG was rechecked immediately, to find the same normal aspect .Troponin levels were slightly above normal range (NR) between 140 and 246 ng/ml (NR < 36ng/ml), LDL cholesterol was elevated at 2,7 g/l (NR < 1.5 g/l) and hyperhomocysteinemia at 15.9 µmol/l (NR < 10 µmol/l) was detected. Glycemia, glycated hemoglobin and the other thrombophilia screening tests were normal. Transthoracic echocardiography (TTE) showed no wall motion abnormality. A myocarditis was suspected upon the normal ECG and TTE and elevated troponin leading the realization of a Cardiac Magnetic Resonance (CMR) which showed neither ischemic heart disease nor myocarditis features. A coronary angiogram was realized, revealing a total thrombotic occlusion of the LAD mid segment (Fig. 2). The Right coronary artery was dominant allowing an important collateralization of the LAD (Fig. 3) with complete epicardial recipient filling (Rentrop 3). Stenting of the culprit lesion was performed restoring the coronary blood flow with good outcomes. Discussion Here we report an uncommon case of a young patient with hypercholesterolemia, a history of chest pain, and elevated troponin but no ECG and cardiac imaging abnormalities including CMR. On the coronary angiogram, the patient had acute total LAD occlusion treated with drug eluting stent implantation raising the question of the nature of the mechanisms involved explaining the huge contrast between the ECG and imaging findings and the LAD lesion severity. ECG is commonly used in patients presenting to the emergency departments suspected of having acute myocardial infarction (AMI). The initial ECG had been widely used to determine the likelihood of the presence of AMI. 3 Acute LAD coronary artery occlusions are typically represented as ST-segment elevation in the anterior leads, and less commonly as ST-segment depression or T- wave repolarization abnormalities on the surface ECG. 2 The mechanisms by which ECG waveforms can be preserved with a totally occluded major epicardial coronary vessel are multiple. The location of the myocardial infarct, its distance from the surface electrocardiogram, non-transmural necrosis, the size of infarcted muscle, history of previous MIs, the presence of dense collaterals, and the delay between ECG realization and vessel occlusion, are all factors involved in the absence of ECG abnormalities in the context of an AMI. 4 In this particular case, the absence of ECG abnormalities might be directly correlated to the small undetected myocardial infarction 3 as they were no CMR myocardial infarction signs, no highly elevated biomarkers and no complications such as heart failure. In fact, it has been reported that at least 3% of the left ventricle must be involved to have ECG abnormalities. Usually in those cases the culprit lesion was found to be a small side branch of the native major coronary arteries 3 , contrasting here with the total occlusion of the LAD. To the best of our knowledge, our case is therefore the first report of a complete occluded LAD presenting with a persistently normal ECG. Certainly, in our case report, almost the entire anterior wall must have been in jeopardy since the LAD was completely occluded. This leads us to think that the dominant right coronary artery, from where develops an important collaterality is responsible for the maintenance of the subendocardial microvascular coronary circulation of the territory of the LAD, thus the absence of any MI signs. This collaterality may have been developed during the two months time lapse of exertional angina due to LAD stenosis, prior to the acute chest pain. Conclusion The absence of ECG abnormalities, despite a major coronary occlusion, can be attributed to factors such as the infarct's location, non-transmural necrosis, the presence of dense collateral circulation, and timing of the ECG. This patient’s lack of ECG changes, combined with normal CMR and biomarker results, suggests an undetectable or very small myocardial infarction due to the important collaterality from RCA. This case report demonstrates that a normal ECG in the context of clinical symptoms consistent with acute coronary syndromes should not lull the clinician into proceeding with an initially conservative approach as normal ECGs do not rule out severe coronary artery occlusion. Abbreviations LAD Left Anterior Descending (Artery) ECG Electrocardiogram CCS Canadian Cardiovascular Society NR Normal Range LDL Low-Density Lipoprotein TTE Transthoracic Echocardiography CMR Cardiac Magnetic Resonance RCA Right Coronary Artery MI Myocardial Infarction AMI Acute Myocardial Infarction Declarations Participant Consent Statement Written informed consent was obtained from the patient for participation in this study and for the publication of the clinical case, including all accompanying images and relevant data. References Zimetbaum PJ, Josephson ME. Use of the electrocardiogram in acute myocardial infarction. N Engl J Med. 2003;348(10):933-940. doi:10.1056/NEJMra022700. Parker AB, Waller BF, Gering LE. Usefulness of the 12-lead electrocardiogram in detection of myocardial infarction: electrocardiographic-anatomic correlations-Part I. Clin Cardiol. 1996;19(1):55-61. Caceres L, Cooke D, Zalenski R, Rydman R, Lakier JB. Myocardial infarction with an initially normal electrocardiogram--angiographic findings. Clin Cardiol. 1995;18(10):563-568. doi:10.1002/clc.4960181004. Arjomand H, Mascarenhas DA, Ye S, Spodick DH. Normal electrocardiogram with total occlusion of the left anterior descending coronary artery. J Invasive Cardiol. 1999;11(8):500- 502. Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6635377","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":454708736,"identity":"d6b44c0b-fb9a-45c3-bcd3-4a946fbb3128","order_by":0,"name":"Mehdi Ayoub 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14:29:51","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6635377/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6635377/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82701012,"identity":"f703eb97-87da-45cf-a2ca-57a509792651","added_by":"auto","created_at":"2025-05-14 09:33:38","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":71103,"visible":true,"origin":"","legend":"\u003cp\u003eInitial ECG at the emergency room showing no abnormalities\u003c/p\u003e","description":"","filename":"FIG1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6635377/v1/e970f5af97187ea60784a184.jpg"},{"id":82700263,"identity":"f7f7b61a-108e-4123-8cb3-7dd9c2cda90c","added_by":"auto","created_at":"2025-05-14 09:25:38","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30831,"visible":true,"origin":"","legend":"\u003cp\u003eRight anterior oblique cranial view with the arrow demonstrating a thrombotic occlusion of the LAD mid segment.\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6635377/v1/d8ae75f32fd01152fd9908c3.jpg"},{"id":82700261,"identity":"1d5a5e11-5521-47a4-9e65-d2cb746fb075","added_by":"auto","created_at":"2025-05-14 09:25:38","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":45342,"visible":true,"origin":"","legend":"\u003cp\u003eLeft anterior oblique view showing a dominant right coronary artery with an important collaterality and with complete epicardial recipient filling (Rentrop 3) of the occluded LAD.\u003c/p\u003e","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6635377/v1/0229152ecc8e1ae2d7af2b4e.jpg"},{"id":82701014,"identity":"02d38d85-9c15-481e-ad22-4a78c8ee0978","added_by":"auto","created_at":"2025-05-14 09:33:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":479700,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6635377/v1/e6a90aac-a094-4965-a2c9-aed70ca798cf.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eNormal electrocardiogram and imaging in a young patient with acute left anterior descending coronary artery occlusion : an unusual case report\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eWe report the case of a young male with an acute occluded proximal left anterior descending (LAD) coronary artery, without ischemic changes on initial or subsequent electrocardiogram (ECG) or cardiac imaging abnormalities and discuss the different mechanisms involved in those misleading findings.\u003c/p\u003e \u003cp\u003eStandard ECG is the most important diagnostic tool in patients with suspected acute coronary syndrome\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e.It is an easily accessible and rapid diagnostic tool in patients presenting to hospital with acute chest pain. In acute coronary syndromes, ischemic ECG changes depends on the ECG timing, the position of the culprit vessel territory from ECG leads, the leads arrangement used and the myocardium mass involved.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eWe report the case of a 34-year-old north African male with a newly discovered hypercholesterolemia as cardiovascular risk factor who presented to the emergency room, 48 hours prior to admission, with a brief acute chest pain (\u0026lt;\u0026thinsp;15 min), radiating to the left upper limb. He had already been complaining of Canadian Cardiovascular Society (CCS) stage 2 angina for 1 month, neglected by the patient. The patient denied any use of illicit drugs (cannabis, cocaine, etc\u0026hellip;). The physical examination showed a conscious patient with no chest pain, with normal blood pressure, heart rate and no sign of acute heart failure or other complications.12-lead ECG (Fig.\u0026nbsp;1) showed no features suggesting acute ischemia .The ECG was rechecked immediately, to find the same normal aspect .Troponin levels were slightly above normal range (NR) between 140 and 246 ng/ml (NR\u0026thinsp;\u0026lt;\u0026thinsp;36ng/ml), LDL cholesterol was elevated at 2,7 g/l (NR\u0026thinsp;\u0026lt;\u0026thinsp;1.5 g/l) and hyperhomocysteinemia at 15.9 \u0026micro;mol/l (NR\u0026thinsp;\u0026lt;\u0026thinsp;10 \u0026micro;mol/l) was detected. Glycemia, glycated hemoglobin and the other thrombophilia screening tests were normal. Transthoracic echocardiography (TTE) showed no wall motion abnormality. A myocarditis was suspected upon the normal ECG and TTE and elevated troponin leading the realization of a Cardiac Magnetic Resonance (CMR) which showed neither ischemic heart disease nor myocarditis features. A coronary angiogram was realized, revealing a total thrombotic occlusion of the LAD mid segment (Fig.\u0026nbsp;2). The Right coronary artery was dominant allowing an important collateralization of the LAD (Fig.\u0026nbsp;3) with complete epicardial recipient filling (Rentrop 3). Stenting of the culprit lesion was performed restoring the coronary blood flow with good outcomes.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHere we report an uncommon case of a young patient with hypercholesterolemia, a history of chest pain, and elevated troponin but no ECG and cardiac imaging abnormalities including CMR. On the coronary angiogram, the patient had acute total LAD occlusion treated with drug eluting stent implantation raising the question of the nature of the mechanisms involved explaining the huge contrast between the ECG and imaging findings and the LAD lesion severity.\u003c/p\u003e \u003cp\u003eECG is commonly used in patients presenting to the emergency departments suspected of having acute myocardial infarction (AMI). The initial ECG had been widely used to determine the likelihood of the presence of AMI. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Acute LAD coronary artery occlusions are typically represented as ST-segment elevation in the anterior leads, and less commonly as ST-segment depression or T- wave repolarization abnormalities on the surface ECG.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe mechanisms by which ECG waveforms can be preserved with a totally occluded major epicardial coronary vessel are multiple. The location of the myocardial infarct, its distance from the surface electrocardiogram, non-transmural necrosis, the size of infarcted muscle, history of previous MIs, the presence of dense collaterals, and the delay between ECG realization and vessel occlusion, are all factors involved in the absence of ECG abnormalities in the context of an AMI.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn this particular case, the absence of ECG abnormalities might be directly correlated to the small undetected myocardial infarction\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e as they were no CMR myocardial infarction signs, no highly elevated biomarkers and no complications such as heart failure. In fact, it has been reported that at least \u003cb\u003e3%\u003c/b\u003e of the left ventricle must be involved to have ECG abnormalities. Usually in those cases the culprit lesion was found to be a small side branch of the native major coronary arteries\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e, contrasting here with the total occlusion of the LAD. To the best of our knowledge, our case is therefore the first report of a complete occluded LAD presenting with a persistently normal ECG.\u003c/p\u003e \u003cp\u003eCertainly, in our case report, almost the entire anterior wall must have been in jeopardy since the LAD was completely occluded. This leads us to think that the dominant right coronary artery, from where develops an important collaterality is responsible for the maintenance of the subendocardial microvascular coronary circulation of the territory of the LAD, thus the absence of any MI signs. This collaterality may have been developed during the two months time lapse of exertional angina due to LAD stenosis, prior to the acute chest pain.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe absence of ECG abnormalities, despite a major coronary occlusion, can be attributed to factors such as the infarct's location, non-transmural necrosis, the presence of dense collateral circulation, and timing of the ECG. This patient\u0026rsquo;s lack of ECG changes, combined with normal CMR and biomarker results, suggests an undetectable or very small myocardial infarction due to the important collaterality from RCA. This case report demonstrates that a normal ECG in the context of clinical symptoms consistent with acute coronary syndromes should not lull the clinician into proceeding with an initially conservative approach as normal ECGs do not rule out severe coronary artery occlusion.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eLAD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLeft Anterior Descending (Artery)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eECG\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eElectrocardiogram\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCCS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCanadian Cardiovascular Society\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNR\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNormal Range\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLDL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLow-Density Lipoprotein\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTTE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTransthoracic Echocardiography\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCMR\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCardiac Magnetic Resonance\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRCA\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRight Coronary Artery\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMyocardial Infarction\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAMI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcute Myocardial Infarction\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eParticipant Consent Statement Written informed consent was obtained from the patient for participation in this study and for the publication of the clinical case, including all accompanying images and relevant data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZimetbaum PJ, Josephson ME. Use of the electrocardiogram in acute myocardial infarction. N Engl J Med. 2003;348(10):933-940. doi:10.1056/NEJMra022700.\u003c/li\u003e\n \u003cli\u003eParker\u0026nbsp;AB,\u0026nbsp;Waller\u0026nbsp;BF,\u0026nbsp;Gering\u0026nbsp;LE.\u0026nbsp;Usefulness\u0026nbsp;of\u0026nbsp;the\u0026nbsp;12-lead\u0026nbsp;electrocardiogram\u0026nbsp;in\u0026nbsp;detection of myocardial infarction: electrocardiographic-anatomic correlations-Part I. Clin Cardiol. 1996;19(1):55-61.\u003c/li\u003e\n \u003cli\u003eCaceres\u0026nbsp;L, Cooke D, Zalenski R, Rydman R, Lakier JB. Myocardial infarction with an initially\u0026nbsp;normal\u0026nbsp;electrocardiogram--angiographic\u0026nbsp;findings.\u0026nbsp;Clin\u0026nbsp;Cardiol.\u0026nbsp;1995;18(10):563-568. doi:10.1002/clc.4960181004.\u003c/li\u003e\n \u003cli\u003eArjomand H, Mascarenhas DA, Ye S, Spodick DH. Normal electrocardiogram with total occlusion of the left anterior descending coronary artery. J Invasive Cardiol. 1999;11(8):500- 502.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Mohammed V Military Instruction Hospital , Rabat , Morocco","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"acute coronary syndrome, normal electrocardiogram, normal imaging, coronary occlusion","lastPublishedDoi":"10.21203/rs.3.rs-6635377/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6635377/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAcute occlusion of the left anterior descending coronary artery typically presents with significant electrocardiogram abnormalities and positive cardiac biomarkers, indicative of myocardial ischemia. However, the absence of these findings can obscure diagnosis, particularly in young patients with no significant prior medical history.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To highlight the diagnostic challenge posed by acute anterior myocardial infarction presenting with a completely normal electrocardiogram and imaging findings in a young adult, and to emphasize the importance of maintaining clinical suspicion despite reassuring non-invasive assessments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase : \u003c/strong\u003eWe report the case of a 34-year-old north African man, previously healthy, who presented with typical chest pain suggestive of myocardial ischemia. Despite multiple normal electrocardiograms, slightly elevated cardiac biomarkers, and normal cardiac imaging, the patient's clinical presentation prompted further evaluation. Coronary catheterization revealed an acute occlusion of the left anterior descending artery, likely related to hypercholesterolemia. The patient underwent successful percutaneous coronary intervention with good outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e A normal ECG in the context of clinical symptoms consistent with acute coronary syndromes should not lull the clinician into proceeding with an initially conservative approach as normal electrocardiogram do not rule out severe coronary artery occlusion.\u003c/p\u003e","manuscriptTitle":"Normal electrocardiogram and imaging in a young patient with acute left anterior descending coronary artery occlusion : an unusual case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-14 09:25:33","doi":"10.21203/rs.3.rs-6635377/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6c242fa2-9eab-48ac-b9e0-5f3a42d94a2c","owner":[],"postedDate":"May 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":48346795,"name":"Cardiac \u0026 Cardiovascular Systems"}],"tags":[],"updatedAt":"2025-05-14T09:25:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-14 09:25:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6635377","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6635377","identity":"rs-6635377","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}