Abstract | BACKGROUND: CASE SUMMARY: A 61-year-old female smoker with a history of hypercholesterolaemia presented via the primary percutaneous coronary intervention pathway with sudden onset of shortness of breath, dizziness, and chest pain while walking. Transradial coronary angiography revealed a normal left main coronary artery, large left anterior descending artery that wrapped around the apex and dominant left circumflex artery with the non-obstructive disease. The RCA was not selectively entered despite multiple attempts. The left ventriculogram showed normal left ventricle (LV) systolic function. She was in cardiogenic shock with a persistent ectopic atrial rhythm with retrograde p-waves and stabilized with intravenous dobutamine thus avoiding the need for a transcutaneous venous pacing system. A computed tomography pulmonary angiogram demonstrated no evidence of pulmonary embolism while an urgent cardiac gated computed tomography revealed a recessive RCA with ostial occlusive lesion. A cardiac magnetic resonance imaging confirmed RV free wall infarction. She was managed conservatively and discharged to her local district general hospital after 5th day of hospitalization at the tertiary centre. DISCUSSION: This case describes a relatively rare myocardial infarction presentation that can present with many disease mimics which can require as in this case, a multi-modality imaging approach to establish the diagnosis.
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Authors | Adeogo Akinwale Olusan, Paul Francis Brennan, Paul Weir Johnston |
Journal | European heart journal. Case reports
(Eur Heart J Case Rep)
Vol. 5
Issue 1
Pg. ytaa494
(Jan 2021)
ISSN: 2514-2119 [Electronic] England |
PMID | 33554025
(Publication Type: Journal Article)
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Copyright | © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. |