PMC8462894_01
Electrocardiogram showing ST segment elevation in lead V3, V4 and V5 with Q waves in II, III and AVF
ZJCH_A_1942671_F0001_PB.jpg
PMC8462894_01_ZJCH_A_1942671_F0001_PB.jpg
f0001
AVF [Figure 1]. A diagnosis of acute ST elevation MI was made and oral aspirin 325 mg, clopidogrel 300 mg, atorvastatin 80 mg and 3500 units/kg of heparin were administered.
Left heart cath. showing patent left coronaries
ZJCH_A_1942671_F0002_PB.jpg
PMC8462894_01_ZJCH_A_1942671_F0002_PB.jpg
f0002
Coronary angiography showed chronic total right coronary artery occlusion with collaterals from left and patent left coronary arteries [Figures 2and 3].
Left heart cath. showing occlusion of RCA with collaterals from left
ZJCH_A_1942671_F0003_PB.jpg
PMC8462894_01_ZJCH_A_1942671_F0003_PB.jpg
f0003
Coronary angiography showed chronic total right coronary artery occlusion with collaterals from left and patent left coronary arteries [Figures 2and 3].
Left ventriculography shows wall motion abnormalities with mid to apical akinesis and basal hyperkinesis
ZJCH_A_1942671_F0004_PB.jpg
PMC8462894_01_ZJCH_A_1942671_F0004_PB.jpg
f0004
Left ventriculography revealed wall motion abnormalities with mid to apical akinesis and basal hyperkinesis [Figure 4].
Two-dimensional echocardiogram shows mid-to-apical ballooning of the right and left ventricle
ZJCH_A_1942671_F0005_PB.jpg
PMC8462894_01_ZJCH_A_1942671_F0005_PB.jpg
f0005
Approximately 12 hours later, transthoracic echocardiography revealed left ventricular ejection fraction 25-30%, elevated left ventricular end diastolic pressure and akinesis of left and right ventricle except in the basal region [Figure 5].
Two-dimensional echocardiography with definity showing LV thrombus
ZJCH_A_1942671_F0006_PB.jpg
PMC8462894_01_ZJCH_A_1942671_F0006_PB.jpg
f0006
A day later, a repeat echocardiogram showed sessile LV thrombus and akinesis of both left and right ventricles except in the basal region [Figure 6].