PMC5782419_01
12 lead electrocardiogram showing ST-segment elevation at V3-V4 with reciprocal changes at lead II and III
AJM-8-37-g001.jpg
PMC5782419_01_AJM-8-37-g001.jpg
F1
A 12 lead electrocardiogram was performed showing 2 mm ST-elevation in leads V3 and V4 with reciprocal inferior lead changes [Figure 1].
Coronary angiography at the time of her presentation at the outline hospital. (a) Severe stenosis at mid right coronary artery. (b) Repeat angiography after nitroglycerin infusion with near complete resolution of the right coronary artery stenosis. (c) Moderate-severe stenosis at proximal left anterior descending artery. (d) Repeat angiography after nitroglycerin infusion with near complete resolution of the left anterior descending coronary stenosis
AJM-8-37-g002.jpg
PMC5782419_01_AJM-8-37-g002.jpg
F2
A diagnostic left heart cardiac catheterization (LHC) revealed significant mid left anterior descending (LAD) and right coronary artery (RCA) stenosis consistent with coronary vasospasm that resolved with administration of intracoronary nitroglycerin and nicardipine [Figure 2a-d].
Cardiac magnetic resonance imaging, (a) Mid ventricular short axis slice demonstrating transmural infarct (red arrows) of the anterior septum with evidence of microvascular obstruction (white arrows) on delayed gadolinium. (b) Two-chambers view showing transmural infarction (red arrows) of the anterior septum with evidence of microvascular obstruction (white arrows) delayed gadolinium
AJM-8-37-g003.jpg
PMC5782419_01_AJM-8-37-g003.jpg
F3
Cardiac magnetic resonance imaging revealed a LVEF of 29% and late gadolinium enhancement showing transmural infarction in the distal LAD territory and evidence of microvascular obstruction [Figure 3a and b].
Cardiac monitor rhythm strips. (a) ST-segment elevation associated with chest pain when the patient woke up in the morning. (b) Resolution of ST-segment elevation and chest pain after two sublingual nitroglycerin 0.4 mg tablets
AJM-8-37-g004.jpg
PMC5782419_01_AJM-8-37-g004.jpg
F4
These episodes were resolved with sublingual nitroglycerin in 5-10 min interval [Figure 4a and b].