PMC5288504_01
Acute anterolateral ST-segment elevation myocardial infarction (a). Note ST elevations in anterior precordial leads V2-V5, lateral limb leads I and aVL, and reciprocal changes in III and aVF. Resolution of ST-segment abnormalities and inferior reciprocal changes after sublingual nitroglycerin and intra-arterial nitroglycerin and verapamil at the time of angiography via radial sheath (b).
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His electrocardiogram demonstrated ST-segment elevations in leads V2-V6, I, and aVL along with reciprocal changes in leads III and aVF, concerning for an acute anterior ST-segment elevation myocardial infarction (STEMI) (Figure 1(a)). A repeat electrocardiogram after his coronary angiogram demonstrated normalization of his ST-segment abnormalities (Figure 1(b)).
Straight AP cranial (a) and left anterior oblique cranial (b) projections of normal left anterior descending coronary artery.
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Coronary angiography showed normal coronary arteries with TIMI III flow without any angiographic evidence of stenosis, dissection, embolism, or plaque rupture (Figure 2).
Apical four-chamber echocardiographic images with contrast enhancement at end-diastole (a) and end-systole (b) showing severe akinesis of the left ventricular apex (arrows).
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An echocardiogram was performed and demonstrated significant akinesis of the left ventricular apex (Figures 3(a) and 3(b)), findings that were confirmed with abnormal longitudinal strain in the apical segments (Figure 4).
Abnormal longitudinal strain function confined to the left ventricular apex.
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An echocardiogram was performed and demonstrated significant akinesis of the left ventricular apex (Figures 3(a) and 3(b)), findings that were confirmed with abnormal longitudinal strain in the apical segments (Figure 4).
Cardiac magnetic resonance imaging with demonstration of patchy and some full-thickness late gadolinium enhancement of the (a) distal anteroapical wall segments, inferoapical segment, and (b) mid septum (arrows).
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In addition, cMRI confirmed areas of abnormal delayed gadolinium enhancement in both a patchy and full-thickness configuration along the mid and distal anterior wall and the mid septum (Figures 5(a) and 5(b)).