PMC4493291_01
Initial ECG showing ST elevations in V2-V5, II, III, and AVF which are consistent with anterolateral and inferior STEMI.
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fig1
ST segment elevations (Figure 1). She received Aspirin 325 mg, Clopidogrel 600 mg, and Heparin 5000 U in the ED and was sent for emergent cardiac catheterization.
Cardiac catheterization demonstrating severe mid to distal LAD occlusion.
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She was found to have a long, tortuous 99% mid and distal left anterior descending (LAD) lesion with Grade I flow (Figure 2).
Cardiac catheterization after stent placement showing return of the blood flow in the LAD territory.
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Thrombolysis in Myocardial Infarction (TIMI) III Grade flow restored (Figure 3). The right and left circumflex coronary vessels were angiographically normal.
EKG after showing resolution of STE now shows new STE in V3-V4 while the patient was complaining of recurrent CP approximately 15 hours after cardiac catheterization.
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STE in ECG leads V2-V5 (Figure 4). She was started on Heparin and Abciximab.
After second intervention cardiac catheterization showed distal LAD stent thrombosis with TIMI Grade 0 flow.
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fig5
The mid LAD stent was patent, but there was 100% thrombosis of the distal LAD stents (Figure 5).