Full Text (PDF)
Journal of Cardiovascular Medicine and Surgery 11(2):p 75-78, May -Aug 2025. | DOI: 10.21088/jcms.2454.7123.11225.5
Case Report
Simultaneous tombstone ST elevations in Anterior and Inferior Leads
Atit A Gawalkar, Mohan Prasad Akkineni, Krishna Prasad Akkineni, Souvik Sarda, Goutam Kintada
Author Information
Licence:
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
Journal of Cardiovascular Medicine and Surgery 11(2):p 75-78, May -Aug 2025. | DOI: 10.21088/jcms.2454.7123.11225.5
How Cite This Article:
Akkineni MP, Akkineni KP, Sardar S, et al. Simultaneous tombstone ST elevations in Anterior and Inferior Leads. Indian J Cardiovasc Med Surg. 2025;11(2):75-78.Timeline
Received : July 21, 2025
Accepted : August 12, 2025
Published : August 30, 2025
Abstract
ECG changes of ST elevation and reciprocal ST depressions are necessary for diagnosis of ST elevation myocardial infarction which requires urgent revascularization. The reciprocal changes are crucial and help to differentiate from other conditions like pericarditis. However, sometimes in myocardial infarction ST elevations can occur in both anterior and inferior leads which are electrically opposite leading to a confounding situation.
References
- 1. Sadanandan S, Hochman JS, Kolodziej A, et al. Clinical and angiographic characteristics of patients with combined anterior and inferior ST-segment elevation on the initial electrocardiogram during acute myocardial infarction. Am Heart J. 2003 Oct;146(4):653-61.
- 2. Zheng J, Lin J, Shen N, et al. Proximal complete occlusion of right coronary artery presenting with precordial ST-segment elevation: A case report. Medicine (Baltimore). 2016 Oct;95(41):e5113.
- 3. Guo XH, Yap YG, Chen LJ, et al. Correlation of coronary angiography with “tombstoning” electrocardiographic pattern in patients after acute myocardial infarction. Clin Cardiol. 2000 May;23(5):347-52.
- 4. Pollak PM, Parikh SV, Kizilgul M, et al. Multiple culprit arteries in patients with ST segment elevation myocardial infarction referred for primary percutaneous coronary intervention. Am J Cardiol. 2009 Sep 1;104(5):619-23.
- 5. Goel S, Narang R, Gawalkar AA. Challenges in localisation of culprit artery in STEMI. J Electrocardiol. 2025 Feb 21;90:153901.
- 6. Rioufol G, Finet G, Ginon I, et al. Multiple atherosclerotic plaque rupture in acute coronary syndrome: a three-vessel intravascular ultrasound study. Circulation. 2002 Aug 13;106(7):804-8.
- 7. Møller JE, Engstrøm T, Jensen LO, et al; DanGer Shock Investigators. Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. N Engl J Med. 2024 Apr 18;390(15): 1382-1393.
- 8. Yip HK, Chen MC, Wu CJ et al. Acute myocardial infarction with simultaneous ST-segment elevation in the precordial and inferior leads: evaluation of anatomic lesions and clinical implications. Chest. 2003 Apr;123(4):1170-80.
- 9. Jim MH, Chan AO, Tang MO et al. Angiographic and clinical implications of combined STsegment elevation in anterior and inferior leads in acute myocardial infarction. Clin Cardiol. 2009 Jan;32(1):21-7.
- 10. Alzand BS, Gorgels AP. Combined anterior and inferior ST-segment elevation Electrocardiographic differentiation between right coronary artery occlusion with predominant right ventricular infarction and distal left anterior descending branch occlusion. J Electrocardiol. 2011 May-Jun;44(3):383-8.
Data Sharing Statement
There are no additional data available.
Funding
This research received no funding.
Author Contributions
All authors contributed significantly to the work and approve its publication.
Ethics Declaration
Informed consent was taken from the patient’s family for publication as the patient expired during the course of treatment.
Acknowledgements
Information not provide.
Conflicts of Interest
The authors report no conflicts of interest in this work.
About this article
Cite this article
Akkineni MP, Akkineni KP, Sardar S, et al. Simultaneous tombstone ST elevations in Anterior and Inferior Leads. Indian J Cardiovasc Med Surg. 2025;11(2):75-78.
Licence:
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
| Received | Accepted | Published |
|---|---|---|
| July 21, 2025 | August 12, 2025 | August 30, 2025 |
DOI: 10.21088/jcms.2454.7123.11225.5
Keywords
Simultaneous ST elevationsTombstoningLocalizationSearch for Similar Articles
Similar Articles
- Giant Intra-cardiac Lipoma in the Right Atrium
- Case Report: Neurophysiological Facilitation of Respiration in an Infant with...
- Left Coronary Artery Fistula Masquerading as Coronary Insufficiency: A Rare Sur...
- Hemodynamic Monitoring by Point-of-Care Ultrasound: A Multiorgan, Physiology-Dri...
- Aortotomy Closure after Cardiac Valve Replacements: Nightmare for Surgeons
Article Level Metrics
Last UpdatedMonday 22 June 2026, 10:44:39 (IST)
681
Accesses
8
121
00
Citations
NA
NA
NA
Download citation
Article Keywords
Keyword Highlighting
Highlight selected keywords in the article text.
Timeline
| Received | July 21, 2025 |
| Accepted | August 12, 2025 |
| Published | August 30, 2025 |
licence
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
