Occlusion left main incomplete

This typical electrocardiographic finding corresponds to a left main incomplete occlusion and... 

The same pattern (STf in VR) in case of an NSTE-ACS with ST-segment depression in many leads suggests the incomplete occlusion of the left main trunk (LMT) (Yamaji et al, 2001) or its equivalent (very proximal LAD occlusion + LCX) in patients with previous subendocardial ischaemia (Figures 4.59-4.61). 

Figure 4.9 (A) In case of diffuse subendocardial circumferential injury due to incomplete occlusion of left main trunk (LMT) in a heart with previous important subendocardial ischaemia, the injury vector that points circumferential subendocardial area is directed from the apex towards the base, from forward to backwards and from left to right. This explains the typical morphology of...

Figure 4.59 (A) The ECG of a patient with ACS and the ECG typical of tight but incomplete occlusion of the left main coronary artery (see coronary angiography) (B) in the presence at basal state of important and circumferential subendocardial ischaemia. There is ST-segment depression in more than eight leads and clear ST-segment elevation in VR. Note that the maximum depression occurs in V3-V4 without final positive T wave in V4-V5.

---