67-Year Old Male with Exertional Mid-Sternal Chest Pain in the Setting of Proximal LAD Stenosis.
Authors: Back Kim MD, Nay Htyte MD & Tae An Choi, ANP
Heart Vein NYC, New York, New York
67-year old male with exertional mid-sternal chest pain, relieved by rest, since 2 weeks ago.
- Past medical history: Hypertension
- Meds: no medications.
- VS: BP 150/95, HR 65, afeb, RR 14
- Baseline EKG: Normal sinus rhythm without no evidence of acute ischemia (figure 1)
- Resting Echo: Normal EF without wall motion abnormality.
- Treadmill stress: 9 METs 5:oo mins, Duke treadmill score -9 (figure 2 & 3)
- Angiogram: 99% stenosis in the proximal left ascending artery (LAD) with TIMI 1 flow. The left circumflex (Cx) and right coronary artery (RCA) were normal (figure 4), Normal EF (65%).
- PCI: Successful balloon angioplasty and stent deployment without any residual coronary stenosis and TIMI-3 flow in the LAD (figure 5 & 6). Normal EF (65%).
- Outcome: Complete resolution of chest pain.
- Take home points: Sometimes it’s refreshing to be reminded we can still make an impact. And don’t discount a good old fashion history and regular treadmill stress.