PMC3334481_01
(A) Electrocardiogram of the conus branch occlusion. (B) Electrocardiogram of the patient showed atrioventricular block 1 month before the onset of AMI. (C) Elevation of ST segment in leads V1 through V3 was seen in the outside clinic after sublingual nitroglycerin was given, and (D) resolution of ST-segment elevation after the recanalization using the guidewire.
nihms366713f1.jpg
PMC3334481_01_nihms366713f1.jpg
F1
ST segment in the precordial leads (V1 through V3) (Fig. 1A). Sublingual nitroglycerin was given, and the patient was transferred to the emergency room of our hospital. The electrocardiogram showed mild ST-segment elevation in the leads V1 through V3 (Fig. 1B). The maximum elevation of ST segment was 2 mm in the lead V2 (Fig. 1C) recorded 3 hours after the onset of the chest pain as compared with the ECG 1 month before the admission (Fig. 1A). Trial (TIMI) grade III flow was restored as demonstrated in the following coronary angiography (Fig. 2D), suggesting successful recanalization. The resolution of chest pain was immediate. Intravenous infusion of heparin with oral warfarin (3 mg/day) and aspirin (100 mg/day) was initiated. The electrocardiogram taken at 24 hours after recanalization showed the resolution of ST elevations in leads V1 through V3 without the development of Q-wave or T-wave inversion (Fig. 1D).
Coronary angiograms before and after the penetration of guidewire into the conus branch occlusion. The conus branch of the RCA showed total occlusion (arrows in A and B). The TIMI flow grade was 0 at this point. A guidewire was penetrated into the conus branch lesion (arrowhead in C), and grade III TIMI flow was observed (D). RAO indicates right anterior oblique; LAO, left anterior oblique.
nihms366713f2.jpg
PMC3334481_01_nihms366713f2.jpg
F2
Trial (TIMI) grade III flow was restored as demonstrated in the following coronary angiography (Fig. 2D), suggesting successful recanalization. The resolution of chest pain was immediate. Intravenous infusion of heparin with oral warfarin (3 mg/day) and aspirin (100 mg/day) was initiated. The electrocardiogram taken at 24 hours after recanalization showed the resolution of ST elevations in leads V1 through V3 without the development of Q-wave or T-wave inversion (Fig. 1D).