PMC9638725_01
Electrocardiography: normal sinus rhythm, T-wave inversion and V1-V4 ST elevation with Q wave compatible with apical aneurism.
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Biphasic T-wave inversion with V1-V4 ST-elevation compatible with anterior-septal myocardial infraction was seen on a bedside electrocardiogram (Fig. 1).
Panel A: shows SCAD of LAD in AP cranial. Panel B: shows SCAD of LAD in LAO cranial. Panel C: shows normal CX. Panel D: shows normal right coronary arteries.
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The result of angiography was intersiting as SCAD of left anterior descending (LAD) with thrombolysis in myocardial infarction 0 flow with normal circumflex (CX) and right coronary arteries (Figs. 2A-C).
Panel A: LAD wiring and 1.5 x 15 mm balloon pre-dilatation. Panel B: Mid LAD 2.75 x 24 mm DES implantation. Panel C: Proximal LAD 3.0 x 16 mm DES implantation. Panel D: post-dilation with 3.5 x 20 non-compliance (NC) balloon. Panel E: final view.
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The LAD was pre-dilated with a 1.5 x 15 mm balloon, the mid LAD was implanted using 2.75 x 24 mm, the proximal LAD was implanted using 3.0 x 16 mm DES, and finally, final angiography views were taken (Figs. 3A-D).
Panel A: Echo: parasternal short axis of the left ventricle with mild aneurysm. Panel B: apical 4 chamber view with apical thrombus of 0.63 x 1.24 cm.
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Post PCI Echocardiography revealed apical hypokinesia, aneurysmatic with a 0.63 x 1.24 cm thrombus, an ejection fraction (EF) of 40%-45% and mild mitral regurgitation (Figs. 4A & B).
Brain CT scan: In the left frontal lobe, a 4 cm sized hypo dense lesion.
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Due to the history of stroke the patient was sent for carotid Doppler ultrasound and brain CT scan (Fig. 5).