PMC5727555_01
Admission EKG showing ST segment elevations in leads II, III, AVF, and V3-V5.
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fig1
He had an elevated troponin I at 21.9 ng/ml and an EKG ST segment elevation in the inferior leads (Figure 1).
Left coronary angiogram with normal left coronary anatomy with no obstructing atheroma.
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fig2
A STEMI alert was placed, and patients had an emergent left cardiac catheterization that reported normal coronary anatomy with no obstructing coronary stenosis (Figures 2 and 3).
Right coronary angiogram with normal left coronary anatomy with no obstructing atheroma.
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fig3
A STEMI alert was placed, and patients had an emergent left cardiac catheterization that reported normal coronary anatomy with no obstructing coronary stenosis (Figures 2 and 3).
Delayed postcontrast cardiac MRI 2-chamber view demonstrates midmyocardial enhancement in the inferior wall of the left ventricle adjacent to the apex. The subendocardial region is sparred (right arrow). Mild pericardial delayed enhancement (left arrow).
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fig4
At this point, a cardiac MRI was done (Figures 4-7) that demonstrated epicardial and midmyocardial enhancement in the inferior wall, sparing of the subendocardial region, and overlying focal pericardial enhancement, consistent with EKG changes.
Corresponding T2 images of cardiac MRI 2-chamber view with an apical focal area of high T2 signal intensity in midmyocardium indicating focal edema at the apex.
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fig5
At this point, a cardiac MRI was done (Figures 4-7) that demonstrated epicardial and midmyocardial enhancement in the inferior wall, sparing of the subendocardial region, and overlying focal pericardial enhancement, consistent with EKG changes.
Delayed postcontrast cardiac MRI short axis view demonstrating midmyocardial enhancement of the inferior wall of the left ventricle adjacent to the apex. Subendocardial sparring is again seen.
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fig6
At this point, a cardiac MRI was done (Figures 4-7) that demonstrated epicardial and midmyocardial enhancement in the inferior wall, sparing of the subendocardial region, and overlying focal pericardial enhancement, consistent with EKG changes.
T1-weighted cardiac MRI short axis view demonstrating early enhancement ratios in the posterior epicardium and myocardium soon after gadolinium injection with sparing of the subendocardium (blue arrow).
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fig7
At this point, a cardiac MRI was done (Figures 4-7) that demonstrated epicardial and midmyocardial enhancement in the inferior wall, sparing of the subendocardial region, and overlying focal pericardial enhancement, consistent with EKG changes.