case_images: PMC6560259_01
case_images: A) Standard 12-lead electrocardiogram (ECG) at initial presentation, showing an ST-segment elevation in the inferior leads (II, III, and aVF) and leads V3 - V5, along with an ST-segment depression in leads I and aVL. B) Right precordial lead ECG at initial presentation, revealing an ST-segment elevation in leads V3R-V6R. C) Posterior precordial leads at initial presentation, showing no significant ST deviation in leads V7 - V9.
case_images: JTHC-14-28-g001.jpg
case_images: PMC6560259_01_JTHC-14-28-g001.jpg
case_images: F1
case_images: Her electrocardiography revealed a normal sinus rhythm with an ST-segment elevation in the inferior leads, leads V3-V5, and leads V3R-V5R, along with an ST-segment depression in leads I and aVL (Figure 1).
case_images: Coronary angiograms of the patient: Diffuse critical stenoses (arrows) are seen in the left anterior descending (and the left circumflex arteries in the right anterior oblique (RAO) caudal view (A) and in the right coronary artery (RCA) in the left anterior oblique (LAO) view (B). Noncritical coronary plaques after the intracoronary nitroglycerine injection are seen in the coronary arteries in the ROA views of coronary angiography (C and D). Left ventriculography in the RAO view shows a good left ventricular size and function (E).
case_images: JTHC-14-28-g002.jpg
case_images: PMC6560259_01_JTHC-14-28-g002.jpg
case_images: F2
case_images: Due to profound hemodynamic instability, the patient was immediately transferred to the cardiac catheterization unit, where urgent coronary angiography revealed diffuse and severe stenoses in the entire coronary artery tree (Figure 2. Control images illustrated near-normal left coronary arteries (Figure 2. Left ventriculography revealed a good left ventricular size and systolic function without regional wall-motion abnormalities (Figure 2E).