PMC5414016_01
(a) Electrocardiogram (ECG) during episode of chest pain showing prominent ST elevations in the anterior leads (8 mm in lead V3 and 5 mm in lead V4). The rhythm is normal sinus at a rate of 78 beats per minute. The right axis deviation and the left ventricular hypertrophy by voltage criteria are unchanged from the presenting ECG. Prominent U waves seen on initial ECG are no longer present. (b) Initial coronary angiogram: right anterior oblique caudal view of the left anterior descending coronary artery (LAD) showing a 95% long and hazy stenosis of the mid-LAD segment (arrow). The incomplete filling of the LAD on this static frame is due to thrombolysis in myocardial infarction (TIMI)-2 flow observed on cine. A 30%-40% stenosis of the left circumflex first obtuse marginal branch is also visualized. (c) Post- percutaneous coronary intervention coronary angiogram: the 95% mid-LAD stenosis is now converted to a 0% and TIMI-3 flow is restored.
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ST elevations in the anterior leads consistent with anterior wall ST elevation myocardial infarction (Figure 1a). Standard acute coronary syndrome treatment was promptly initiated. He underwent successful percutaneous coronary intervention of the proximal and mid LAD segments with 2 overlapping Vision bare metal stents converting the hazy 95% stenosis to 0% and restoring TIMI-3 antegrade flow (Figure 1b and c).