A 58-year-old male patient with no morbid history, who in August 2001 presented with progressive chest pain, oppressive in nature, with initial intensity on a scale of analogous assessment (EVA) 5 of 10
After 3 hours of evolution of her symptoms.
Upon admission, the patient was alert and oriented, with heart rate of 62 beats per minute, blood pressure of 149/89 mmHg, respiratory rate of 16 per minute with precordial pain intensity VAS 9/10.
A 12-lead electrocardiogram (ECG) showed ST-segment elevation in the inferior wall and V1.
AMI was diagnosed with ST-segment elevation, medical management was initiated and a catheterization laboratory was activated.
Coronary angiography was performed 45 minutes after admission with no visualization of the right coronary artery (RCA) (2A), anterior descending artery (ADA) and circumflex artery (ACx) without lesions.
The left coronary artery was diagnosed as a middle ostial lesion of the RCA, but a second opinion suggested the existence of a possible anomalous birth, so it was decided to perform a selective sinus injection in which the RCA was confirmed.
PPA was performed with stent implantation (2C), achieving a flow rate of 3 in RCA, without residual lesion (2D).
Post-reperfusion ECG showed normalization of the ST segment.
The enzymatic curve is shown in Table 1.
The patient was hemodynamically stable, with no complications during the evolution of her AMI, and was discharged 72 hours later.
Echocardiogram showed akinesia of the lower basal third of the wall and posterior septum, with moderate hypokinesia of the middle and posterior apical third, with preserved systolic function in normal range, mild right atrial size dilatation with normal ventricle.
She was discharged on the sixth day of hospitalization with acetyl salicylic acid, clopidogrel, atenol, simvastatin.
The patient was asymptomatic and had no new events at 5 years of follow-up.
