Electronic ISSN 2287-0237

VOLUME

EMERGENT PRIMARY CORONARY ANGIOPLASTY SAVED LIVES IN LEFT MAIN SHOCK SYNDROME: A REPORT OF TWO CASES WITH DIFFERENT MANIFESTATIONS AND MANAGEMENT

FEBRUARY 2012 - VOL.3 | CASE REPORT
Keywords:

Left main coronary artery occlusion, Cardiogenic shock, ST elevation acute myocardial infarction, primary (direct) angioplasty

MEDIA
Figure 1:
Coronary angiogram showed intra-luminal thrombus in the body of the left main coronary artery (arrow) causing a subtotal luminal stenosis (A). An unobstructed right coronary is shown in B.
Figure 2:
Balloon dilatation (2.0/20) was performed during cardiopulmonary resuscitation (A) an resulted in re-established coronary flow with residual stenosis of less than 20% (open arrow in B).
Figure 3:
Coronary angiogram performed 2.5 years later in 1998 and showed a smooth lumen of the left main trunk with no re-stenosis.
Figure 4:
The 1st ECG of case report 2 showed diffuse ST segment depression in leads I, aVL, II, V2-V6 (black arrow) and > 1mm ST elevation in leads aVR and V1 (white arrow). Early transition (tall R in V2) suggested posterior wall extension.
Figure 5:
Showed a totally occluded distal LM artery (black arrow, left) and unobstructed right coronary artery (middle) that provided a major collateral supply to distal part of the left coronary artery (white arrows). After balloon dilatation, the flow improved to Cx and proximal LAD/diagonal arteries (black arrow, right) but we could not pass the wire across an obstructed LAD artery.
Figure 6:
Upper tracing showed frequent short coupling premapure vemtricular complexes (PVCs) (black arrow) induced non-sustained VT (in bracket) during and after balloon dilatations resulted in transient hypotension (arterial pressure 50-60 mmHg in lower tracing)
Figure 7:
ECG after PTCA showed improvement of ST depression in all leads and lesser degree of ST elevation in lead aVR. Tall R in V1, Q in V2 and tall T in V1-3 were also noted.
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