The first acute myocardial infarction (MI) of an elderly
male was determined through angiography to be due to an infarct of the
circumflex artery. The angiogram also revealed chronic occlusion and diffuse
disease of the left anterior descending artery (LAD). This had been compensated
for by collateral circulation from the right coronary artery. Since the patient
had no prior history of coronary artery disease, the chronic and collateralized
disease of the LAD was presumed to be stable and this artery was not
treated. Due to a history of aspirin intolerance a bare metal stent was implanted
in the circumflex artery. Within hours after stenting the patient had a second
acute MI. Despite no change in the angiogram, the EKG suggested that the LAD
was the source of the second MI. Indeed, a drug-eluting stent implanted in the
LAD resolved the patient’s signs and symptoms and he was discharged with a
favorable outcome. The surprising second MI and the inconsistent stenting illustrate
that when the unexpected occurs, there is no substitute for the judgment of
a skilled clinician.
Cite this paper
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