PMC2990100_01
12-lead electrocardiogram demonstrating significant ST-depression in the posterior leads during exercise.
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fig1
As symptoms increased in intensity and frequency, another stress test in January 2009 at our institution revealed exercise induced ST-depression in leads V4-V6 accompanied by typical anginal symptoms (Figure 1).
Left coronary artery (RAO 31, caudal 0,4).
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fig2
A second cardiac catheterization demonstrated a mild stenosis in the mid portion of the left anterior descending coronary artery (LAD), all other coronary arteries were without visible stenosis (Figures 2 and 3).
Right coronary artery (LAO 53, caudal 0,3).
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fig3
A second cardiac catheterization demonstrated a mild stenosis in the mid portion of the left anterior descending coronary artery (LAD), all other coronary arteries were without visible stenosis (Figures 2 and 3).
Spontaneous occlusion of the left anterior descending coronary artery (LAO 35, cranial 18) accompanied by ST-segment elevation.
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fig4
The LAD was found occluded beginning at the stenotic segment of the mid LAD (Figure 4).
Resolution of spasm following intracoronary nitroglycerine (LAO 35, cranial 18).
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fig5
All symptoms and the spasm resolved spontaneously (Figure 5).
Occlusion of the left anterior descending coronary artery following intracoronary acethylcholine infusion (LAO 35, cranial 18) accompanied by ST-segment depression and T-wave inversion.
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fig6