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)

Heart Vein NYC Case Study 2

  • Resting Echo: Normal EF without wall motion abnormality.
  • Treadmill stress: 9 METs 5:oo mins, Duke treadmill score -9 (figure 2 & 3)

Heart Vein NYC Case Study 2Heart Vein NYC Case Study 2

  • 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%).

Heart Vein NYC Case Study 2

  • 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%).

Heart Vein NYC Case Study 2Heart Vein NYC Case Study 2

  • 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.
NYU Langone Logo
Lenox Hill Hospital Logo
Northwell Health Logo
Columbia University Medical Center Logo

Request Appointment

Thank you for contacting us! We will get in touch with you shortly.