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The first acute myocardial infarction MI of an elderlymale was determined through angiography to be due to an infarct of thecircumflex artery. The angiogram also revealed chronic occlusion and diffusedisease of the left anterior descending artery LAD. This had been compensatedfor by collateral circulation from the right coronary artery. Since the patienthad no prior history of coronary artery disease, the chronic and collateralizeddisease of the LAD was presumed to be stable and this artery was nottreated. Due to a history of aspirin intolerance a bare metal stent was implantedin the circumflex artery. Within hours after stenting the patient had a secondacute MI. Despite no change in the angiogram, the EKG suggested that the LADwas the source of the second MI. Indeed, a drug-eluting stent implanted in theLAD resolved the patient’s signs and symptoms and he was discharged with afavorable outcome. The surprising second MI and the inconsistent stenting illustratethat when the unexpected occurs, there is no substitute for the judgment ofa skilled clinician.


Clinical Medicine; Angiography; Angioplasty; Bare Metal Stent; Drug-Eluting Stent; Collateral Circulation; Aspirin Intolerance; Emotional Stress in Hospitalized Heart Patients; Team Communication

Cite this paper

A. Allen -State of the Art in Cardiac Intervention: A Case Report,- International Journal of Clinical Medicine, Vol. 3 No. 7, 2012, pp. 628-632. doi: 10.4236-ijcm.2012.37112.

Autor: Allen D. Allen



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