Different ECG patterns of left main coronary artery occlusion signifying varying degrees of ischemic severity.

Many ischemic ECG patterns are found in patients with acute left main coronary artery occlusion. We present a patient with dynamic ECG changes that corresponded to changes in his clinical symptoms and hemodynamic status. These changes signify different severity of myocardial ischemia caused by left main coronary artery disease. Take-home Message: Our case with left main coronary artery disease illustrated three distinct ECG patterns with different severity of clinical symptoms signifying varying severity of ischemia. In left main coronary artery disease, the ST deviations in the precordial leads can be relatively minor. Left axis deviation or left anterior fascicular block with broad QRS possibly reflects left ventricular depolarization delay secondary to extensive ischemia.