Acute left main coronary artery occlusion with South African flag sign on electrocardiogram: a case report
By
Fangming Zhong
Baiqing Lin
Qifeng Zhang
July 8, 2026
Clinical Scorecard: Acute Occlusion of the Left Main Coronary Artery Associated with South African Flag Sign on ECG: A Case Study
At a Glance
Category Detail
Condition Acute Occlusion of the Left Main Coronary Artery Key Mechanisms South African Flag Sign (SAFS) indicating potential acute high lateral wall myocardial infarction. Target Population Patients presenting with chest pain and suspected acute coronary syndrome. Care Setting Emergency department and cardiac catheterization laboratory.
Key Highlights
SAFS may indicate severe coronary artery pathology, including LMCA occlusion. Emergency coronary angiography revealed complete occlusion of the LMCA. Successful percutaneous coronary intervention restored optimal blood flow. Patient recovered without complications and showed no adverse events at follow-up. Guideline-Based Recommendations
Diagnosis
ECG interpretation should consider clinical context and confirmatory angiography. Management
Immediate coronary angiography for suspected LMCA occlusion. Monitoring & Follow-up
Follow-up hs-cTnI measurements to assess myocardial injury. Risks
Potential for severe myocardial infarction and complications if LMCA occlusion is misdiagnosed. Patient & Prescribing Data
69-year-old woman with primary hypertension.
Medication regimen included aspirin, ticagrelor, atorvastatin, ezetimibe, metoprolol, and telmisartan.
Clinical Best Practices
Heightened clinical vigilance when interpreting ECG with SAFS. Integration of ECG findings with clinical presentation and urgent angiography. Related Resources & Content
