case_images: PMC11774424_01
case_images: (a) Initial electrocardiogram (ECG): Sinus rhythm, heart rate 75 bpm, R wave amputation in precordial leads, left anterior fascicular block, T-wave inversion in V2-V6, I and aVL, ST segment elevation in V3-V5, suggestive of late presentation anterior wall myocardial infarction, (b) Second ECG: Sinus rhythm, heart rate 107 bpm, widening (160 ms), with right bundle branch block morphology in precordial leads and left bundle branch block in extremity leads, and ST elevation in V3-V4
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case_images: A 12-lead electrocardiogram (ECG) was obtained [Figure 1a], as well as high-sensitive troponin I, with a value of 51,345 ng/L (reference range: 0-40 ng/L). A new ECG was obtained [Figure 1b].
case_images: Transthoracic echocardiogram showing an 8-mm apical ventricular septal defect
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case_images: Based on the clinical course, the ECG findings and the murmur, a transthoracic echocardiogram was performed, showing a left ventricular ejection fraction of 22%, dyskinesia of all apical and mid-segments and an apical 8 mm VSD [Figure 2].
case_images: Coronary arteriography: (a and b) Proximal left anterior descending coronary artery occlusion (white arrow) and (c) Severe lesion of the mid (upper white arrow) and distal thirds (lower white arrow) of the right coronary artery
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case_images: Coronary arteriography [Figure 3] showed an occlusion of LAD coronary artery and severe disease of the right coronary artery (RCA).