PMC7559851_01
(a) ECG in the emergency department. (b) ECG at the admission to the ICU. (c) ECG taken 12 h after pPCI. (d) ECG taken 4 months after pPCI.
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fig1
The initial electrocardiogram (ECG) showed 2 mm ST segment elevation in leads II, III, and aVF; 1 mm in V6; and horizontal ST depression in aVL and V1-3 (Figure 1(a)). II, III, aVF, and V5-6 and ST denivelation in aVL and V1-3 (Figure 1(b)). Initial troponin on presentation was 41 ng/L (referent value < 40 ng/L). T wave in lead III (Figure 1(c)). The laboratory test showed LDL levels of 2.85 mmol/L and total cholesterol of 4.79 mmol/L.
(a) Left anterior descending artery:proximal segment subocclusion. (b) Left anterior descending artery:RAO. (c) Right coronary artery. (d) Left anterior descending artery after pPCI with drug eluting stent (4 x 15mm).
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Coronary angiogram showed right-dominant system (Figure 2).
Peak longitudinal strain 3 days after myocardial infarction showing reduced strain in basal anteroseptolateral segments while inferior and posterior segment remained intact.
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Three days after pPCI, echocardiographic global longitudinal strain was -13.8% with reduced strain in basal anteroseptolateral segments of the left ventricle, while inferior and posterior segments remained intact (Figure 3).
MSCT coronary angiography showed no signs of stenosis and no variations in coronary anatomy.
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Three months after myocardial infarction, multislice computed tomography (MSCT) coronary angiography was performed, showing no variations in coronary anatomy (including "wrapped" LAD), no abnormal heart rotation, and no signs of stenosis (Figure 4).