A 70-year-old male patient was admitted to the emergency room of the Hospital Pablo Tobón Uribe, with a clinical picture of cocaine 100 hours after onset consisting of chest oppression, malaise, asthenia and weight loss.
The patient, as the only clinical history, suffered from hypertension, controlled pharmacologically and denied previous episodes of angina or nitrate consumption.
The clinical examination and vital signs were normal; however, after the initial assessment, she presented cardiorespiratory arrest secondary to ventricular fibrillation, responding to a single 200 joule characterization.
The initial electrocardiogram showed ST-segment elevation in the derivatives of the lower face (II, III and aVF) and anterior face (V2-V4) with reciprocal changes in the aVL to the right ventricle with no extension.
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Cardiac enzymes at admission revealed a creatine phosphokinase (CK) of 170 and a creatine phosphokinase MB fraction (CK-MB) of 6.
Electrolytes, coagulation tests and blood cell counts were normal.
Initial management was performed with aspirin 100 mg, lovastatin 40 mg each day, metoprolol 25 mg every 12 hours, enoxaparin 60 mg every 12 hours, oxygen at 3 lquinasa/min and star 50 000 units.
No changes secondary to reperfusion were demonstrated.
The patient was transferred to the intensive care unit where episodes of complete AV block with spontaneous resolution were documented during the first hours of evolution.
The EKG taken at 24 hours of evolution revealed QS in the lower face and a late progression of the R wave in the anterior face.
Enzymatic follow-up showed an increase in CK and MB fraction at 6 hours (4476 and 165) and 12 hours (3839 and 136).
The next day a coronary angiography showed diffuse disease of the anterior descending artery with lesion in the distal third of 50% and lesion of 40% in the proximal third of the first diagonal branch.
The circumflex artery had a 50% lesion in the middle third and diffuse disease of its marginal obtuse branches.
The right coronary artery had an irregular lesion suggestive of partially resolved thrombus producing maximum stenosis of 50%; distally the posterior descending artery had two lesions of 40%.
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The patient recovered satisfactorily without further pain-free complications.
She was discharged for outpatient follow-up.
