PMC9242800_01
Initial electrocardiogram of the referral site. Sinus rhythm and ST-segment depression in V4-V5-V6 (lateral aspect).
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fig1
It was decided to perform an electrocardiogram in which ST depression was interpreted in V4-V5-V6 (Figures 1 and 2).
Initial electrocardiogram of the referral site (posterior leads). Sinus rhythm and extension of ischemia to the posterior face of the heart is ruled out.
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fig2
It was decided to perform an electrocardiogram in which ST depression was interpreted in V4-V5-V6 (Figures 1 and 2).
Initial electrocardiogram in a high-complexity hospital. Sinus rhythm, heart rate 75 bpm, QTc 521, QRS 70, PR 154, and prominent precordial T waves.
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fig3
An electrocardiogram was taken, which reported sinus rhythm, heart rate of 79 bpm, QTc 521, QRS 70, PR 154, and prominent precordial T waves (Figure 3).
Transthoracic echocardiogram.
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fig4
Due to electrocardiographic findings and positive troponin (biomarker), a transthoracic echocardiogram was requested (Figure 4), reporting a normal-sized left ventricle, moderate hypokinesia of the middle segment of the anterior and lateral wall, normal contractility of the rest of the segments, LVEF (left ventricular ejection fraction) 55%, no diastolic dysfunction, the right ventricle of normal size and systolic function, TAPSE (tricuspid annular plane systolic excursion): 21 mm, nonquantifiable pulmonary systolic pressure, valvular apparatus without relevant alterations, size atria normal, pericardium and great vessels without relevant alterations, IS/IVS without defects or shunts, no intracavitary thrombi, and normal in the rest of the study.
Coronary arteriography.
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fig5
Due to presumed myocardial injury and high suspicion of coronary artery disease, coronary angiography was requested, which showed epicardial coronary arteries, without angiographically significant stenosis (Figure 5), thus confirming the presence of Kounis syndrome.