JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
CLINICAL CASE OF THE MONTH
A 65-Year-OldWoman with Left Main Coronary Artery Thrombosis
Bashar Ababneh, MD, Vijay Ravipati, MD, Murtuza Ali, MD, Fred Lopez, MD
Cardiogenic shock due to left main coronary artery thrombosis is rare and associated with high mortality and poor prognosis. Urgent revascularization and hemodynamic support are vital to improving survival. We discuss a case of left main thrombosis as a culprit for myocardial infarction.
CASE PRESENTATION
A 65-year-old woman with past medical history of psoriasis, hypertension, hyperlipidemia and smoking presented to the emergency department (ED) with a five-day history of intermittent palpitations that became persistent and increased in intensity the morning of presentation and were associated with fatigue. She denied any other symptoms. Shewas not taking any medications and was allergic to codeine. She denied use of alcohol or illicit drugs. Her family history was noncontributory. In the emergency department, vitals included a pulse of 107 beats per minute, blood pressure of 125/70 mmHg, temperature of 97.8° F, respiratory rate of 19 breaths per minute, and oxygen saturation of 100% on room air. Her physical examination was unremarkable. The presenting electrocardiogram revealed sinus tachycardia, ST elevation in aVR and diffuse ST-segment depression (Figure 1).
catheterization laboratory for coronary arteriography. After right coronary artery (RCA) injections were completed, left coronary arteriography was conducted. Arteriography of the left coronary artery (LCA) demonstrated a thrombotic lesion in the left main artery (LM), and the patient began experiencing chest pain, diaphoresis, and nausea (Figure 2).
Figure 2: Antero-posterior/caudal image of the left coronary artery before intervention. Arrow points to the LM artery thrombosis. LM: left main artery; LAD: left anterior descending artery; LCx: left circumflex artery.
The patient received a 325mg aspirin tablet and her palpitations resolved. D-dimer and urine toxicology screen were negative. Cardiac enzymes were mildly elevated. After evaluation by the cardiology team, the patient was taken urgently to the Figure 1: The presenting electrocardiogram in the emergency department, showing sinus tachycardia, diffuse ST-depression in the inferoposterior leads, with ST elevation in lead avR.
92 La State Med Soc VOL 170 MAY/JUNE 2018
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