Accepted Cases: Fellows & Young Practitioners Series
1 - STEMI: Repeat Coronary Angiography Unmasks the Culprit Lesion
Saturday, December 19, 2020
9:00 AM – 11:00 AM
Overview: Delayed presentation of STEMI associating viral illness, underwent urgently to the cath lab and no culprit lesion was identified posing more questions about the diagnostic with several differentials. The patient had further chest pain, developing Dressler's syndrome with rising in cardiac biomarkers. As the next step in diagnosis workup, it was organized an inpatient Cardiac MRI which revealed transmural ischaemic septal and anterolateral lesion suggesting the culprit vessel. A decision was made to repeat the coronary angiogram which now revealed an intermediate branch with subtotal ostial occlusion evident not seen on an initial angiogram.
Focal myopericarditis is an important but rare differential diagnosis of STEMI and should be suspected in young patients presenting with features of acute myocardial infarction.
Ostial flush occlusion of a small branch may not be apparent on the initial coronary angiogram.
Cardiac MRI may provide additional information on the likely culprit territory.
OCT and IVUS, are very useful invasive imaging tools to determine the culprit lesion in patients with non-obstructive disease coronary angiograms.