Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 4 4 2019 10 03 e93 e93 Maryam Mehrpooya Department of Interventional Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Amir Salehi Department of Cardiology, Tehran University of Medical Sciences, Tehran, Iran Alborz Sherafati Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2019 08 07 2019 09 06 Introduction: ST-elevation in precordial leads is diagnostic for acute transmural myocardial infarction (MI) related to acute occlusion of left anterior descending artery (LAD). Case presentation: In this case report, a 54-year-old man was admitted to the emergency department (ED) due to chest pain. ST-depression with tall T waves in precordial leads was detected in surface electrocardiogram (ECG). Angiography showed acute total occlusion of proximal LAD and ad hoc percutaneous coronary intervention (PCI) was performed successfully. Conclusion: This case highlights that total occlusion of LAD may present without typical ST-elevation pattern in ECG. https://fem.tums.ac.ir/index.php/fem/article/view/233 https://fem.tums.ac.ir/index.php/fem/article/download/233/232