To report a case of acute occlusion of the left main coronary artery (LMCA) presenting with the South African flag sign (SAFS) on ECG, highlighting its potential association with severe coronary artery pathology.
Approach:
Case Presentation: A 69-year-old woman with primary hypertension presented with chest pain lasting 1.5 hours. Initial ECG showed SAFS, which suggested a high lateral myocardial infarction, but coronary angiography revealed complete LMCA occlusion.
Follow-up: Post-PCI, the patient was managed with a comprehensive medication regimen, leading to an uneventful recovery and discharge without complications.
Key Findings:
The SAFS on ECG can indicate severe coronary artery pathology, including LMCA occlusion.
Emergency coronary angiography is crucial for accurate diagnosis in cases with SAFS.
Successful PCI can restore blood flow in cases of LMCA occlusion, as demonstrated in this case.
Interpretation:
This case highlights the importance of considering LMCA occlusion when SAFS is present on ECG, despite its typical association with first diagonal branch occlusion.
Limitations:
Intravascular imaging was not performed due to the urgent clinical scenario, which may limit the understanding of the occlusion's characteristics.
The findings are based on a single case and may not be generalizable to broader populations.
Conclusion:
This observation broadens the differential diagnosis of SAFS and emphasizes the need for careful ECG interpretation in the context of acute coronary occlusion.
