A case of simultaneous anterior, inferior, and right ventricular ST-segment elevation myocardial infarction due to occlusion of the wrapped left anterior descending coronary artery

Simultaneous anterior, inferior, and right ventricular ST-segment elevation myocardial infarction is an unusual condition. A 50-year-old male patient presented with severe, squeezing chest pain of an hour onset. ST-segment elevations were detected in all precordial derivations, DII, DIII, aVF and V3R, V4R. Coronary angiography showed a significant lesion in the left anterior descending (LAD) coronary artery, just below the second diagonal branch. Balloon predilatation was performed after 40 minutes of admission, followed by bare metal stent implantation, which resulted in ST-segment resolution in all leads and relief of chest pain. Echocardiography showed dyskinesia of the left ventricular apical wall, and hypokinesia of the interventricular septum and inferior wall. Left ventricular ejection fraction was 40%. Coronary angiography and cardiac CT angiography demonstrated a wrapped LAD. The patient was discharged five days after percutaneous coronary intervention (PCI) with stabilization of his clinical status. Ten days after PCI, he presented with chest pain associated with left ventricular anterior and inferior reinfarction. Successful balloon dilatation was performed for thrombotic in-stent restenosis. His clinical condition improved and he was asymptomatic for a month, during which no signs of deterioration were observed in electrocardiographic and echocardiographic findings.