A 37-year-old man known for obesity felt typical chest pain while playing tennis accompanied by nausea, dyspnea, and sudations. The ECG shows STsegment elevation. He is immediately admitted to the catheterization laboratory (Fig. below).
What is the underlying pathology?
Thrombotic occlusion of the left main trunk. The coronary angiography shows thrombotic occlusion of the left main trunk artery. This lesion has been treated with thromboaspiration and implantation of a DES.
A 58-year-old man known for hypertension and smoking suffered chest pain and dyspnea in the previous 48 hours. He consulted emergency department for persisting symptoms. The rest 12-lead ECG at admissions is shown in Figure below.
What is the diagnosis?
Anterior subacute MI. ECG reveals ST elevation of anterolateral fields. Due to persisting chest pain, the patient has been investigated with angiography. The ventriculography showed occlusion of the mid-portion of the left anterior descending coronary artery treated with thromboaspiration and implantation of a BMS. The image of the thrombus extracted is shown in Figure below.
A 28-year-old male smoker presented after wakeup typical inaugural chest pain. The 12-rest ECG at admission is shown in Figure below.
He is transferred immediately to the catheterization laboratory. What is the most likely finding?
Occlusion of the left anterior descending coronary artery. The coronary angiography showed an occlusion of the proximal left anterior descending coronary artery. The fact that the vessel perfused the apex including the inferoapical portion of the left ventricles explains the ST elevations in the anterior and inferior leads.
A 69-year-old man known for hypertension and diabetes consulted emergency department for typical chest pain. The ECG did not show significant changes. Troponins were elevated (1.4 μg/L). Coronary angiography (Fig. below)
shows
Visible thrombus in the mid-portion of the RCA. The coronary angiography showed a subtotal stenosis of the mid-RCA followed by a filling defect compatible with a large thrombus. The thromboaspiration was successfully performed and the lesion was subsequently treated with stenting.
A 41-year-old overweight heavy-smoker construction worker presented with chest pain while on the job associated with diaphoresis and dyspnea. In the field, no ECG could be obtained due to the extreme diaphoresis. In the ambulance, the patient developed hypotension, bradycardia, and subsequently asystole. Under cardiopulmonary resuscitation he was transferred to the cardiac catheterization laboratory and circulation was reestablished using extracorporeal membrane oxygenation. Subsequently, coronary angiography (Fig. below)
Subtotal occlusion of the left main trunk. Coronary angiography showed subtotal occlusion of the left main trunk and the lesion was treated with stenting. Ventriculography showed a severely reduced LVEF (15%) under a mechanical chest compression system. The patient did not recover and subsequently died.
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