PMC3615989_01
Electrocardiogram at presentation.
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Initial electrocardiogram (Fig. 1) showed intermittent right bundle branch block (RBBB), STE-aVR [J elevation, 2 mm; horizontal STE, 1.5 mm]; in addition, STE was observed in V1 [J elevation, 2 mm; horizontal STE, 1.5 mm when no RBBB was observed] with intermittent incomplete (2nd, 3rd, and 7th complexes) or complete (4th and 6th complexes) RBBB.
Coronary angiogram showing sub-occlusive stenosis of the left anterior descending artery along with rudimentary conus branch.
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An emergent coronary angiogram (Fig. 2) showed proximal sub-occlusive LAD stenosis (>90%), with poor progression of dye in the mid and distal segments suggesting the presence of multiple luminal clots; additionally, there was a mild diffuse disease in the left circumflex and in the right coronary artery, from which came off a rudimentary conus branch.
Electrocardiogram at discharge.
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The patient clinical condition improved and stabilized progressively and he was discharged on day 14; pre-discharge EKG (Fig. 3) showed a pathological Q wave from V1 to V3, along with poor progression of R wave in V4-V6, absent Q wave in V5-V6.