case_images: PMC7364231_01
case_images: The patient's EKG on admission, which demonstrates sinus rhythm with nonspecific ST changes in the lateral leads alongside T-wave inversions in lead III. There were no observed ST-segment elevations or ST-segment depressions.
case_images: CRIID2020-8864985.001.jpg
case_images: PMC7364231_01_CRIID2020-8864985.001.jpg
case_images: fig1
case_images: EKG revealed sinus rhythm with nonspecific ST changes in the lateral leads with T-wave inversions in lead III (Figure 1).
case_images: The patient's chest X-ray: (a) PA and (b) lateral. The lungs demonstrated no focal consolidation to suggest pneumonia and no evidence of pulmonary edema, pleural effusion, or pneumothorax. The cardiac silhouette was noted to be within normal limits, and no free air was detected below the diaphragms.
case_images: CRIID2020-8864985.002.jpg
case_images: PMC7364231_01_CRIID2020-8864985.002.jpg
case_images: fig2
case_images: A chest X-ray showed no evidence of focal consolidation, pulmonary edema, pleural effusion, or pneumothorax (Figure 2).
case_images: The patient's EKG on the morning of day 2. There were ST elevations in lead I, aVL, and the precordial leads overlying the anterior and lateral surfaces of the heart (V3-V6), which was consistent with anterolateral infarction. These findings were not present on admission (Figure 1).
case_images: CRIID2020-8864985.003.jpg
case_images: PMC7364231_01_CRIID2020-8864985.003.jpg
case_images: fig3
case_images: On day 2, the morning EKG revealed new anterolateral ST elevations (Figure 3) and transthoracic echocardiogram (TTE) demonstrated an ejection fraction of 35-40% with hypokinesis of the entire apex and the anterolateral segments, suggestive of an anterolateral myocardial infarction (MI).
case_images: The patient's LAD thrombus (black arrow) (a) before and (b) after catheterization. Diagnostic angiography done prior to catheterization demonstrated complete midsegment occlusion of the LAD with no significant disease noted in the left main circumflex artery and the right coronary artery.
case_images: CRIID2020-8864985.004.jpg
case_images: PMC7364231_01_CRIID2020-8864985.004.jpg
case_images: fig4
case_images: The patient was immediately taken to the cardiac catheterization lab, where he was found to have complete midsegment occlusion of the LAD (Figure 4), and a drug-eluting stent (DES) was placed.