PMC7364231_01
The patient's EKG on admission, which demonstrates sinus rhythm with nonspecific ST changes in the lateral leads alongside T-wave inversions in lead III. There were no observed ST-segment elevations or ST-segment depressions.
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EKG revealed sinus rhythm with nonspecific ST changes in the lateral leads with T-wave inversions in lead III (Figure 1).
The patient's chest X-ray: (a) PA and (b) lateral. The lungs demonstrated no focal consolidation to suggest pneumonia and no evidence of pulmonary edema, pleural effusion, or pneumothorax. The cardiac silhouette was noted to be within normal limits, and no free air was detected below the diaphragms.
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A chest X-ray showed no evidence of focal consolidation, pulmonary edema, pleural effusion, or pneumothorax (Figure 2).
The patient's EKG on the morning of day 2. There were ST elevations in lead I, aVL, and the precordial leads overlying the anterior and lateral surfaces of the heart (V3-V6), which was consistent with anterolateral infarction. These findings were not present on admission (Figure 1).
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On day 2, the morning EKG revealed new anterolateral ST elevations (Figure 3) and transthoracic echocardiogram (TTE) demonstrated an ejection fraction of 35-40% with hypokinesis of the entire apex and the anterolateral segments, suggestive of an anterolateral myocardial infarction (MI).
The patient's LAD thrombus (black arrow) (a) before and (b) after catheterization. Diagnostic angiography done prior to catheterization demonstrated complete midsegment occlusion of the LAD with no significant disease noted in the left main circumflex artery and the right coronary artery.
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The patient was immediately taken to the cardiac catheterization lab, where he was found to have complete midsegment occlusion of the LAD (Figure 4), and a drug-eluting stent (DES) was placed.