PMC10166221_01
Initial electrocardiogram on presentation. Electrocardiogram showed left anterior fascicular block with T wave inversion in the lateral leads.
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Electrocardiogram demonstrated a left anterior fascicular block with lateral ischemic changes (Fig. 1).
Coronary angiogram 6 months prior to presentation. Image A shows coronary angiogram showing LAD dissection with proximal entry point (orange arrow) with distal to apical extension (red arrows). Image B shows complete LAD obstruction with no distal collaterals (red arrows) 24 h post initial presentation.
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Her clinical course was complicated by a ventricular fibrillation arrest due to distal propagation of the dissection and complete occlusion of the LAD (Fig. 2).
Coronary angiogram during current presentation. Coronary angiogram demonstrating LCx (orange arrow) with bifurcating OM1 showing a Type II SCAD (red arrows) and healed LAD with distal atherosclerotic disease (blue arrows).
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Emergency cardiac catheterization showed a Type II SCAD involving the large, bifurcating OM1 (obtuse marginal) branch with distal TIMI 0 flow, and a prior healed LAD dissection with distal TIMI III flow (Fig. 3).