Diagnostic and therapeutic dilemma due to new pattern electrocardiographic change in myocardial infarction: a case report from a remote island

Acute myocardial infarction results due to acute disruption of coronary blood flow, commonly presented with chest pain. Electrocardiogram showing ST-segment elevation in consecutive leads is a classical ST-elevation infarction; however, atypical also can occur. We report an elderly lady who the island health centre intractable central showed V1 and aVR; whereas ST-depression V4-6. With primary management, she was referred regional hospital. Repeat electrocardiogram V1, aVR, III; V4-6, aVL, I. Therefore, considering Aslanger's pattern ECG change infarction, cardiac where angiography revealed severe diffuse triple vessel disease. Primary PCI performed on right artery initially as it culprit stenosis other vessels. staged angioplasty left system. Uncommon electrocardiographic presentations may be encountered daily practice, associated multiple-vessel diseases. So, challenging for cardiologist well during interventions.