PMC4008355_01
Electrocardiogram on admission reveals pathological q waves and nonspecific ST-T wave changes of unknown age in the inferior leads (II, III, and aVF) and early precordial R/S transition suggesting concomitant posterior wall participation.
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fig1
Double inversion recovery FSE. Short axis slice demonstrates increased signal intensity (white arrows) in the basal-mid lateral wall consistent with myocardial oedema.
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fig2
Late gadolinium enhancement. Short axis slice. Following gadolinium, there is transmural delayed enhancement (white arrow) in the basal-mid lateral wall with a central core of noenhancement (black arrowhead) consistent with a recent myocardial infarction with a zone of no-reflow.
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fig3
LGE study (Figure 3). Left atrium (LA), right atrium (RA), and right ventricle (RV) appeared normal in size and function.
Diagnostic coronary angiography demonstrated an unobstructed left anterior descending coronary artery (white arrow) and distal occlusion of a nondominant left circumflex coronary artery (black arrowhead). The dominant right coronary artery (not shown) was normal.
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fig4
This demonstrated distal occlusion of a nondominant left circumflex coronary artery with otherwise unobstructed coronary arteries (Figure 4).