PMC5932506_01
Baseline ECG upon admission showing inferior Q waves, nonspecific ST and T wave changes, and evidence of LVH.
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fig1
Her initial ECG showed sinus rhythm, left ventricular hypertrophy (LVH) by Cornell criteria, and inferior Q waves (Figure 1).
ECG after seizure showing acute interval development of ST elevations at leads II, III, and aVF.
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ST elevations in leads II, III, and aVF (Figure 2). She was loaded with aspirin and ticagrelor and was started on heparin drip.
Mid-right coronary artery lesion.
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fig3
Hospitals Cleveland Medical Center for primary PCI. Her coronary angiography showed a chronically occluded mid-LAD, a mid-LCx with a patent stent, and an 80% in-stent restenosis in the mid-RCA (RCA) at the site of prior intervention with TIMI flow 3 before intervention (Figures 3 and 4).
Left system angiography.
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fig4
Hospitals Cleveland Medical Center for primary PCI. Her coronary angiography showed a chronically occluded mid-LAD, a mid-LCx with a patent stent, and an 80% in-stent restenosis in the mid-RCA (RCA) at the site of prior intervention with TIMI flow 3 before intervention (Figures 3 and 4).
Optical coherence tomography.
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fig5
Optical coherence tomography (OCT) (Figure 5) revealed malapposition of the prior overlapping stent and no thrombus or plaque rupture.
ECG after PCI showing marked resolution of ST elevation in leads II, III, and aVF.
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fig6
Postprocedure ECG showed resolution of the ST segment elevation (Figure 6).