PMC4762468_01
Electrocardiogram on admission and after stent implantation.. Notes: (A) Showing ST segment slope-down depression and T-wave inversion in leads II, III, aVF, and V4-V6; (B) ECG after stent implantation. T-wave amplitudes in leads II, III, aVF were decreased, compared with (A).. Abbreviation: ECG, electrocardiogram.
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Electrocardiogram (ECG) measurements showed ST segment slope-down depression and T-wave inversion on leads II, III, aVF, and V4-V6 (Figure 1). T-wave amplitudes on leads V1-V3 and decreasing T-wave amplitudes on leads II, III, and aVF, compared with those on admission (Figure 1). The anticoagulant and antiplatelet drugs administered after PCI included clopidogrel (75 mg/day) and dalteparin sodium (initially at a dose of 5,000 IU/12 hours, and 2 days later, 5,000 IU/24 hours).
Colon under colonoscopy.. Notes: (A, B) Colonoscopy showing tumor with dirty white-yellow furs in the transverse colon. (C, D) Repeat colonoscopy showing normal colon 10 months after the operation.
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Colonoscopy was performed to exclude gastrointestinal (GI) malignancy (Figure 2) 1 month after NSTEMI, leading to the detection of an infiltrating tumor (non-typical carcinoid in biopsy pathology) in the right segment of the transverse colon with three quarters colon wall involvement and cavity stenosis. Ten months after the operation, repeated colonoscopy disclosed no active bleeding (Figure 2).
Coronary angiogram and PCI.. Notes: (A) Diffuse stricture (70%-85%) of proximal and middle circumflex and focal proximal left anterior descending stenosis 60% on right anterior oblique projection; (B) stenosis on left anterior oblique projection; (C) middle right coronary occlusion, 95% stenosis of the opening of the first sharp edge of branch on right anterior oblique projection; (D) right coronary artery on right anterior oblique after stent implantation; (E) stent thrombosis of right coronary artery on right anterior oblique; (F, G) inflated balloon in proximal and distal parts of the stent during PTCA; (H) right coronary artery after PTCA on right anterior oblique projection.. Abbreviations: PCI, percutaneous coronary intervention; PTCA, percutaneous transluminal coronary angioplasty.
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Coronary angiogram revealed focal proximal left anterior descending stenosis (60%), diffuse stricture (70%-85%) of proximal and middle circumflex, middle right coronary occlusion, 95% stenosis of the opening of the first sharp edge of the branch, and no significant left main stenosis (Figure 3). T-wave amplitudes in leads III, aVF, and V1-V6 (Figure 4). The angiogram revealed stent thrombosis, and recanalization was performed with percutaneous transluminal coronary angioplasty (PTCA) (Figure 3).
ECG during stent thrombosis.. Notes: (A) ECG before recurrent chest pain. (B) Inverted T-waves in leads II, III, and aVF. (C) Increased T-wave amplitudes in leads III, aVF, and V1-V6, compared with (B); (D) ECG after PTCA, decreased T-wave amplitudes in leads II, III, and aVF, compared with (C).. Abbreviations: ECG, electrocardiogram; PTCA, percutaneous transluminal coronary angioplasty.
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T-waves on leads II, III, and aVF (Figure 4). Total CK, CK-MB, and cardiac TnT (cTnT) levels were significantly increased, HB levels decreased from 115 g/L to 79 g/L in 6 days, and the stool occult blood test was positive. T-wave amplitudes in leads III, aVF, and V1-V6 (Figure 4). The angiogram revealed stent thrombosis, and recanalization was performed with percutaneous transluminal coronary angioplasty (PTCA) (Figure 3). T-wave amplitudes in leads II, III, and, aVF (Figure 4). The heart condition was gradually stabilized, and UFH continued until 1 day before surgery.
ECG changes of acute inferior wall myocardial infarction post-operation.. Notes: (A) ECG 1 day before surgery; (B) obvious elevation of ST segment in leads II and III, aVF compared with (A).. Abbreviation: ECG, electrocardiogram.
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ST segment in leads II, III, and aVF (Figure 5). Serum chemistry results showed CK-MB 40.3 U/L and cTnT 0.452 ng/mL, and recurrent acute inferior wall myocardial infarction was diagnosed.