PMC4967697_01
(a) Baseline EKG with RBBB. (b) EKG showing ST elevation in leads V2-V5. (c) EKG showing resolution of the ST elevation following LAD intervention.
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On her second day of hospitalization she reported mild retrosternal chest pain accompanied with a Troponin I elevation up to 0.3 ng/mL with an unchanged EKG showing right bundle branch block (RBBB) (Figure 1(a)). The EKG however showed ST elevation in the anterior leads, V2 to V5 (Figure 1(b)). Ticagrelor, Aspirin, Deltiazem, and Atorvastatin. The chest pain resolved shortly after the intervention and the EKG returned to baseline (Figure 1(c)).
(a) First left heart catheterization showing LAD with minor luminal irregularities. (b) Second left heart catheterization (4 days later) showing the mid-LAD lesion. (c) LAD after intervention.
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On the following day, she underwent a coronary angiogram revealing only minor luminal irregularities and no significant CAD (Figure 2(a)). She was immediately transferred to the catheterization lab where the angiogram surprisingly revealed a filling defect, likely a thrombus, occluding the midsegment of the LAD (Figure 2(b)). Subsequently, a 2.5 x 18 mm drug eluting stent was deployed with pre- and postballoon dilation resulting in TIMI III flow (Figure 2(c)).