PMC4222711_01
EKG initial presentation.. Note: An EKG showed a sinus rhythm with a right bundle branch block (RBBB) but without signs of ischemia.. Abbreviation: EKG, electrocardiogram.
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An electrocardiogram showed a sinus rhythm with a right bundle branch block (RBBB) (Figure 1).
Echocardiogram TEE PFO.. Notes: TEE showed a very minor PFO only with a Valsalva maneuver. Doppler views did not demonstrate a PFO (A). During the Valsalva maneuver, a single bubble became apparent (blue arrow) (B). There was no aortic dissection.. Abbreviations: PFO, patent foramen ovale; TEE, transesophageal echocardiogram.
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Doppler view (Figure 2A). During the Valsalva maneuver, a single bubble became apparent (Figure 2B).
Left heart catheterization.. Note: (A) shows a thrombus in the proximal to mid LAD. (B) shows the dissolution of the thrombus. (C) shows recurrence of thrombus from the second cardiac event months later. (D) shows reperfusion of the vessel after stent placement. The coronary angiography shows a thrombus in the proximal to mid LAD (arrow) in otherwise normal coronary arteries.. Abbreviation: LAD, left anterior descending artery.
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A coronary angiography showed a thrombus in the proximal to mid left anterior descending artery (LAD) in otherwise normal coronary arteries (Figure 3). One week after the onset of chest pain, another coronary angiography showed resolution of the LAD thrombus (Figure 3).
Coronary ultrasound showing vessel walls with mild plaque disease and thrombus lodged in vessel walls of LAD appreciated especially in (C) and (D).. Note: The intravascular ultrasound of the LAD demonstrates mild plaque disease with thrombus lodged in vessel walls of the LAD.. Abbreviation: LAD, left anterior descending artery.
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Intravascular ultrasound showed evidence of thrombotic material in the mid LAD in addition to mild plaque disease, and no evidence of dissection in the left main, proximal, or mid LAD (Figure 4).
EKG second event.. Note: The EKG from the second event showed marked sinus bradycardia with PAC and existing T wave inversions in inferior leads.. Abbreviations: EKG, electrocardiogram; PAC, premature atrial complex.
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T wave inversions in the inferior leads (Table 1 and Figure 5). The patient had a coronary angiography on the day of symptom onset.