case_images: PMC3891160_01
case_images: The initial ECG shows 3 mmV ST elevation in V2,3,4 (A). The 1 day follow-up ECG shows decreased ST elevation in V2,3,4 (B).
case_images: kjim-20-243-g001.jpg
case_images: PMC3891160_01_kjim-20-243-g001.jpg
case_images: F1
case_images: On the initial electrocardiogram, 3 mm ST segment elevation in leads V2 through V4 and Q wave in lead II, III, and aVF was observed (Figure 1A).
case_images: On admission day, there is no active lung lesion in the chest PA (A). On the 7th hospital day, there is pulmonary congestion (B).
case_images: kjim-20-243-g002.jpg
case_images: PMC3891160_01_kjim-20-243-g002.jpg
case_images: F2
case_images: The chest X-ray revealed no abnormalities (Figure 2A). The chest radiograph revealed pulmonary congestion on both sides (Figure 2B).
case_images: The baseline coronary angiogram shows 70% stenosis at the proximal and 90% stenosis at the mid portion of the left anterior descending artery (A) and no residual stenosis is present after successful percutaneous coronary intervention with stent implantation (B).
case_images: kjim-20-243-g003.jpg
case_images: PMC3891160_01_kjim-20-243-g003.jpg
case_images: F3
case_images: Ninety percent stenosis on the 2nd obtuse marginal branch was also observed (Figure 3A). PCI with stent implantation for LAD lesions was successful (Figure 3B).
case_images: Transthoracic Doppler echocardiography reveals a 1.3 cm sized ventricular septal defect at the cardiac apex, and a turbulent shunt flow from the left ventricle (LV) to the right ventricle (RV) through the interventricular septal defect.
case_images: kjim-20-243-g004.jpg
case_images: PMC3891160_01_kjim-20-243-g004.jpg
case_images: F4
case_images: Echocardiography revealed improved wall motion of the anterior wall and the cardiac apex, but a ventricular septal defect approximately 1.3 cm in diameter was observed at the apical septum (Figure 4).