An Interesting ECG Case

65-Year-Old Female with Aslanger Pattern

• A 65-year-old female arrives at the emergency department with central chest pressure and shortness of breath that started 45 minutes ago. She has a history of hypertension and diabetes.

• An urgent ECG is performed on arrival.

ECG demonstrates:

• Sinus rhythm

• Subtle ST elevation in leads aVR, III and V1

• Widespread ST depression in leads I, II, aVL, aVF, and V4–V6

• ST in lead V1 higher than ST in V2

This ECG was thought to represent “Aslanger pattern” (J Electrocardiol. 2020 Jul-Aug;61:41-46). This is suggestive of multivessel coronary artery disease (CAD) or left main coronary artery (LMCA) involvement.

Course:
The patient was treated with IV nitroglycerin and sent for immediate coronary angiography. She had a critical left main disease and diffuse multivessel CAD. She was referred for urgent coronary artery bypass grafting.

Teaching points:

• The Aslanger pattern is characterized by diffuse ST depression with concurrent ST elevation in aVR and sometimes V1. It indicates severe ischemia, often involving the left main coronary artery or multivessel CAD.

• Patients with this pattern are at high risk of hemodynamic collapse and require urgent intervention.

• Always correlate ECG findings with the clinical presentation and consider activating a multidisciplinary team early.