Normal electrocardiogram and imaging in a young patient with acute left anterior descending coronary artery occlusion : an unusual case report

Background: Acute occlusion of the left anterior descending coronary artery typically presents with significant electrocardiogram abnormalities and positive cardiac biomarkers, indicative of myocardial ischemia. However, the absence of these findings can obscure diagnosis, particularly in young patients with no significant prior medical history. Objective: To highlight the diagnostic challenge posed by acute anterior myocardial infarction presenting with a completely normal electrocardiogram and imaging findings in a young adult, and to emphasize the importance of maintaining clinical suspicion despite reassuring non-invasive assessments. Case : We report the case of a 34-year-old north African man, previously healthy, who presented with typical chest pain suggestive of myocardial ischemia. Despite multiple normal electrocardiograms, slightly elevated cardiac biomarkers, and normal cardiac imaging, the patient's clinical presentation prompted further evaluation. Coronary catheterization revealed an acute occlusion of the left anterior descending artery, likely related to hypercholesterolemia. The patient underwent successful percutaneous coronary intervention with good outcomes. Conclusion: A normal ECG in the context of clinical symptoms consistent with acute coronary syndromes should not lull the clinician into proceeding with an initially conservative approach as normal electrocardiogram do not rule out severe coronary artery occlusion.