This 71-year-old male has (1) Type 2 diabetes mellitus, and (2) Hyperlipidemia. He also received surgical treatment for Cerebral aneurysm in 2002. He suffered from intermittent chest tightness recently, and the chest tightness got worse after exercise. He also had shortness of breath.So he visited our CV-OPD for help. ECG showed sinus rhythm but diffuse ST depression.
Treadmill Exercise Stress Test revealed diffuse ST depression and ST elevation in aVR after exercise.
(1) Left Main: Severe Stenosis more than 95% from Ostium to the distal bifurcation.(2) LAD: Orifice more than 95% stenosis; Middle part: around 70% stenosis.(3) LCx: Orifice more than 95% stenosis; Middle part: CTO with intra-coronary collateral circulation.(4) RCA: Generalized atherosclerosis, Distal part more than 95% stenosis.
ECG monitor showed transient ST depression when contrast injection via Left Main. (A)(5).wmv (A)(12).wmv (A)(14).wmv
(1) Percutaneous coronary intervention for severe stenosis of left main is a very high risk procedure (Complexhigh-risk and indicated PCI).(2) The vital signs and LVEF are very important.(3) Consider Mechanical circulatory support with theImpella or IABP or ECMO.