Left anterior descending coronary artery occlusion

A 22-year-old man with a 6-year history of intravenous heroin use was maintained on methadone 60 mg/day and dihydrocodeine 0.5 g/day. He had an extensive anterior myocardial infarction as a result of occlusion of the left anterior descending coronary artery, which was reopened by percutaneous transluminal coronary angioplasty. 

Figure 4.10 In an acute coronary syndrome with ST-segment elevation in V1-V2 to V4-V6 as the most striking pattern, the occluded artery is the left anterior descending coronary artery (LAD). The correlation of the ST-segment elevation in V1-V2 to V4-V5 with the ST morphology in II, III and VF allows us to know if it is an occlusion proximal or distal to D1 (see Figure 4.43). If it is proximal, the involved muscular mass in the anterior wall is large and the injury vector is directed not only forward but also upward, even though there can be a certain...

Arbane M, Goy JJ. Prediction of the site of total occlusion in the left anterior descending coronary artery using admission electrocardiogram in anterior wall acute myocardial infarction. Am J Cardiol 2000 85 487. 

Engelen DJ, Gorgels AP, Cheriex EC et al. Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction. J Am Coll Cardiol 1999 34 389. 

Sapin PM, Musselman DR, Dehmer GJ, Cascio WE. Implications of inferior ST segment elevation accompanying anterior wall myocardial infarction for the angiographic morphology of the left anterior descending coronary artery morphology and site of occlusion. Am J Cardiol 1992 69 860. 

Figure 9. Volume of functional part of left ventricle chamber and of aneurysmal part in a 20.5 kg dog six weeks after occlusion of left anterior descending coronary artery. Data from (Schwartz et aL, submitted 1984).

Two-vessel coronary artery disease (60% right coronary artery [RCA] and 80% left anterior descending artery [LAD] occlusion) after intracoronary CYPHER stent placement to the mid-LAD artery lesion 10 months ago. 

In Fig. 2.2, the PET perfusion images show severe stenosis or occlusion of the left circumflex (LCx) and right (RCA) coronary arteries with a moderately severe stenosis of the left anterior descending (LAD) coronary artery proximal to its second diagonal branch. The ejection fraction (EF) and regional LV contraction were normal. Therefore, this example illustrates purely ischemic myocardium without scar and without injured or poorly contracting myocardium. 

Possible complications include massive myocardial infarction due to retrograde flow around the occlusion balloon, complete heart block, ventricular fibrillation, stroke, dissection of the left anterior descending artery, and right coronary artery thrombosis. Though high grade atrioventricular blockage occurs relatively frequently, procedural mortality rate is low (0-4%) and severe complications are rare and often avoidable (7-10). 

Huey B, Beller G, Kaiser O, Gibson R. A comprehensive analysis of myocardial infarction due to left circumflex artery occlusion comparison with infarction due to right coronary and left anterior descending artery occlusion. J Am Coll Cardiol 1988 12 1156. 

Quyyumi AA, Crake T, Rubens MB, Levy RD, Rickards AF, Fox KM. Importance of reciprocal electrocardiographic changes during occlusion of left anterior descending artery studies during percutaneous transluminal coronary angioplasty. Lancet 1986 1 347. 

A EXPERIMENTAL FIGURE 18-21 Atherosclerosis narrows and blocks blood flow through coronary arteries. X-ray multislice computed tomographic image of a human heart reveals a major occlusion (black arrow) of the left anterior descending artery (LAD, arrow) and a narrowing of a nearby vessel (white arrow) as a block in the stream of blood (seen in the arteries as a white tube). [From K. Nieman et al., 2001, Lancet 357 599.]... 

A 78-year-old man developed anaphylaxis after exposure to peanuts and was given intramuscular adrenaline 0.5 mg with very good response. However, very shortly afterwards he became sweaty and nauseated, without chest pain, but with a tachycardia of 107/ minute and ST segment elevation in the anterior chest leads of the electrocardiogram. He had has a stent inserted for established coronary artery disease in the left anterior descending artery 4 years earlier. Cardiac catheterization showed occlusion of the same artery, without apparent restenosis. 

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