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    "titulo" => "Uncommon electrocardiographic presentation of acute left circumflex coronary artery occlusion"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Electrocardiographic changes before and after stent angioplasty of the culprit lesion&#58; &#40;A&#41; admission electrocardiogram depicting ST-segment depression at the J point in I&#44; II&#44; aVF&#44; III and V3-V6 and ST-segment elevation at the J point in aVR and V1 &#40;aVR&#62;V1&#41;&#59; &#40;B&#41; conventional coronary artery angiographic images depicting &#40;top to bottom&#41; acute proximal occlusion of the left circumflex artery &#40;arrow&#41;&#44; a good result after culprit lesion stenting&#44; an unobstructed left anterior descending artery and high-grade lesions in the right coronary artery &#40;arrowheads&#41;&#59; &#40;C&#41; electrocardiogram after stent angioplasty of the culprit lesion depicting complete resolution of ST-segment changes and signs of inferior &#40;QRS complex fragmentation in aVF and III&#41; and lateral &#40;R-wave amplitude and R&#47;S amplitude ratio in V1 &#62;3 mm and &#62;0&#46;5&#44; respectively&#44; and loss of R-wave height in V6&#41; infarction&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 59-year-old man with a history of stent angioplasty of the left circumflex &#40;LCx&#41; artery presented with sudden-onset retrosternal chest pain associated with ischemic electrocardiographic &#40;ECG&#41; changes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#46; Emergency coronary angiography performed because of ongoing angina despite maximally tolerated therapy disclosed acute in-stent occlusion of the proximal LCx artery&#44; successfully tackled with stenting &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41; resulting in resolution of the ischemic ST-segment changes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In patients presenting with acute coronary syndrome&#44; the ECG pattern comprising ST-segment depression in six or more leads&#44; often with inverted T waves&#44; and ST-segment elevation &#40;&#8805;0&#46;1 mV&#41; in aVR and V1 &#40;aVR&#62;V1&#41; has been associated with circumferential subendocardial ischemia owing to subocclusive left main &#40;LM&#41; or three-vessel coronary artery disease &#40;CAD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> We present this ECG pattern in association with acute LCx artery occlusion&#44; in which the superiorly directed ST-segment vector toward aVR is ascribed to ischemia&#44; most pronounced in the basal inferior &#40;formerly posterior&#41; wall&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Indeed&#44; the post-angioplasty ECG showed fragmented QRS complexes in aVF and III as a manifestation of inferior infarction most pronounced in the basal inferior wall&#44; which&#44; owing to the fact that this area is the last to be depolarized&#44; lacks a necrosis vector&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Furthermore&#44; the infarction extended to the basal lateral wall&#44; as evidenced by a gain in R-wave height in V1 together with a loss of R-wave height in V6&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> In retrospect&#44; absence of heart failure on admission and the presence of a final positive T wave in leads with ST-segment depression may be clues ruling out LM or three-vessel CAD&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Electrocardiographic changes before and after stent angioplasty of the culprit lesion&#58; &#40;A&#41; admission electrocardiogram depicting ST-segment depression at the J point in I&#44; II&#44; aVF&#44; III and V3-V6 and ST-segment elevation at the J point in aVR and V1 &#40;aVR&#62;V1&#41;&#59; &#40;B&#41; conventional coronary artery angiographic images depicting &#40;top to bottom&#41; acute proximal occlusion of the left circumflex artery &#40;arrow&#41;&#44; a good result after culprit lesion stenting&#44; an unobstructed left anterior descending artery and high-grade lesions in the right coronary artery &#40;arrowheads&#41;&#59; &#40;C&#41; electrocardiogram after stent angioplasty of the culprit lesion depicting complete resolution of ST-segment changes and signs of inferior &#40;QRS complex fragmentation in aVF and III&#41; and lateral &#40;R-wave amplitude and R&#47;S amplitude ratio in V1 &#62;3 mm and &#62;0&#46;5&#44; respectively&#44; and loss of R-wave height in V6&#41; infarction&#46;</p>"
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