PMC3898530_01
Initial Electrocardiogram Showing Q-waves in the Inferior Leads
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F1
On arrival at our hospital, the patient denied any chest pain and her electrocardiogram showed sinus bradycardia with small Q-waves in the inferior leads II, III, and AVF (see Figure 1).
Electrocardiogram Obtained During Adenosine Infusion Showing ST Segment Elevation in the Inferior Leads
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F2
There was an additional 1-2mm ST segment depression in the electrocardiographic leads I, AVL, and V2, plus 1-3mm additional ST segment elevation was noted in II, III, and AVF during and up to three minutes-post adenosine infusion (see Figure 2).
Stress Myocardial Perfusion Polar Map Depicting Flow Defect in the Region of the Right Coronary Artery
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F3
The rest and stress (adenosine) myocardial perfusion images revealed normal-sized left ventricle and mild to moderate transient myocardial perfusion defect (mild to moderate ischemia) superimposed on mild fixed myocardial perfusion defect (superimposed on mild scar) involving the inferior, inferoapex, and inferolateral wall of the left ventricle (see Figure 3).
Left Anterior Oblique View of the Right Coronary Artery. Arrow points to the site of stenosis.
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F4
The right coronary artery showed a 75% stenosis in the mid segment (see Figure 4).