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7112403 
Journal Article 
Upsloping ST depression: Is it acute ischemia? 
Alam, M; Nikus, K; Fiol, M; Bayes de Luna, A; Birnbaum, Y; , 
2019 
Yes 
Annals of Noninvasive Electrocardiology
ISSN: 1082-720X
EISSN: 1542-474X 
WILEY 
HOBOKEN 
30387541 
WOS:000465231300018 
We describe a patient with acute coronary syndrome, presenting with upsloping ST depression in leads I, II, V3-V6 and ST elevation in lead aVR. Coronary angiography revealed spontaneous dissection in a big, dominant left circumflex artery. No other lesions identified. During stenting of the dissection site, the distal left circumflex, supplying a large posterior descending artery was occluded, resulting in ST elevation myocardial infarction with ST elevation in lead III and aVF, but not II. This pattern is considered to represent right coronary artery infarction, rather than left circumflex infarction.