High-risk percutaneous coronary intervention in a patient with a single coronary artery presenting as STEMI and cardiogenic shock.
Cardiogenic shock due to ST elevation myocardial infarction in a patient with a single coronary artery involving the sole vessel is a rare presentation. This can be clinically and angiographically challenging. Proper recognition of the topography of diseased vessels and a systematic guarded approach can lead to procedural success. We report a case of an 81-year-old woman who presented with chest pain followed by a near syncope associated with an acute myocardial infarction. Coronary angiography revealed a single proximally occluded right coronary artery and an anomalous left main coronary artery (originating from the proximal right coronary artery) and occluded distal left circumflex artery. The right coronary artery was successfully stented following predilation without compromising the anomalous left main origin. The flow in the chronically occluded left circumflex artery (originating from the anomalous left main) which was depended on the retrograde supply from right coronary artery through collaterals, was also re-established.
Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA.
Murad
M
Abdelsalam
Pinnacle Health Cardiovascular Institute, Harrisburg, Pennsylvania, USA.
Mrinalini
M
Krishnan
Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA Division of Cardiology, University of Illinois College of Medicine at Peoria, OSF Saint Francis Medical Center, Peoria, Illinois, USA.
Sandeep
S
Banga
Pinnacle Health Cardiovascular Institute, Harrisburg, Pennsylvania, USA.
William B
WB
Bachinsky
D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*