PMC6759782_01
Electrocardiograme demonstrating symmetrical T wave inversions in the anterolateral leads concerning for ischemia.
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F1
T wave inversions (see Figure 1) therefore it was deemed necessary to take the patient for urgent coronary angiography with possible percutaneous intervention to evaluate for obstructive coronary artery disease. The patient was taken to the cardiac catheterization laboratory and successfully underwent a left heart catheterization with selective left and right coronary angiogram (see Figures 2A,B) which did not reveal any significant obstructive atherosclerotic coronary artery stenosis; except a non-occlusive lesion in left circumflex artery which was not significant enough for any intervention and less likely to cause our patients acute symptoms and echocardiographic findings.
(A) Coronary angiogram showing left coronary artery circulation with a non-occlusive lesion in proximal left circumflex artery. (B) Coronary angiogram showing right coronary artery circulation.
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F2
T wave inversions (see Figure 1) therefore it was deemed necessary to take the patient for urgent coronary angiography with possible percutaneous intervention to evaluate for obstructive coronary artery disease. The patient was taken to the cardiac catheterization laboratory and successfully underwent a left heart catheterization with selective left and right coronary angiogram (see Figures 2A,B) which did not reveal any significant obstructive atherosclerotic coronary artery stenosis; except a non-occlusive lesion in left circumflex artery which was not significant enough for any intervention and less likely to cause our patients acute symptoms and echocardiographic findings.
(A,B) Left ventriculography demonstrating apical ballooning and hypokinesis of the apex with normal functioning basal inferior and anterior segments.
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F3
Left ventriculography performed at the time demonstrated notable apical ballooning and hypokinesis of the apex with normal functioning basal, anterior, lateral, and inferior walls (see Figures 3A,B) as well as an ejection fraction estimated at 30% consistent with TCM.
(A,B) Transthoracic echocardiogram with definity contrast demonstrating hypercontractility of the basal wall and akinesis of the mid to distal anteroseptal wall, anterior wall, mid to distal inferior and inferolateral walls, and apex.
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F4
Her echocardiogram post-cardiac catheterization reported a left ventricular ejection fraction on 30% with hypercontractility of the basal wall and akinesis of the mid to distal anteroseptal wall, anterior wall, mid to distal inferior and inferolateral walls, and apex consistent with TCM (see Figures 4A,B).