Left main trunk occlusion

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...

The electrocardiographic pattern of subendocardial injury in patients with ACSs is recorded in different leads, depending on the coronary artery involved and the location of the injured area. When the ischaemia is due to left main trunk (LMT) subocclusion or equivalent, or 3 proximal vessel diseases, the involvement of the left ventricle is circumferential. In case of single vessel disease or when in presence of multivessel disease, the active ischaemia is due to a culprit artery or two distal occlusions the involvement is considered regional (Sclarovsky 1989). The correlation between these... 

Mirror image - In general, yes. - Sometimes more prominent than the direct image Vi- V3 in some cases of lateral Ml. - In general, no. - ST elevation in VR and sometimes in Vi in case of non-complete occlusion of the left main trunk or equivalent and in 3 vessel disease. 

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