A 45 year old gentleman- a known case of old AWMI (post PTCA to LAD in 2011) presented to us with severe retrosternal chest pain & dyspnoea a/w sweating for last 3 hours. The patient was in Killip Class IV with Cardiogenic shock and recurrent VT.The patient was put on high inotropic & Bipap support.
ECG shows LBBB, Diffuse ST depression in all leads except aVR & V1 & ST elevation in I aVL & AVR. 2D-ECHO suggestive of Severe LV Systolic Dysfunction (LVEF=20%), Severe MR, Moderate TR, Moderate PAH.
This case shows the importance of primary angioplasty of the Left Main in such critically ill cases where emergency CABG is not practically feasible. Percutaneous intervention with stent implantation for LMCA disease has become a standard procedure in contemporary practice with safety, expedited recovery, and durability. Precise selection of the strategy aided by intracoronary imaging, functional evaluation, and mechanical support when needed have improved the immediate and long-term results in this high risk intervention. It is however important to have a team approach and operator expertise before embarking on LMCA interventions.