- Patient initials or identifier number:
-Relevant clinical history and physical exam:
The 53 years old man with type 2 DM presents with chest pain for three months. The pain was located at the left chest wall, radiated to the left arm, aggravated by exertion and relieved by rest. He had a positive exercise stress test from the referral hospital and was referred for coronary angiography. His cardiovascular examination was normal.
-Relevant test results prior to catheterization:
His resting EKG was within normal, but the stress ECG test showed deep down-sloping ST depression at III, aVF and V4-6 during the maximal exercise test. He achieved a work level of METS 8. He had a normal heart rate response and blood pressure response during the test. The resting echocardiogram showed normal LV systolic function (LVEF 67%) without wall motion abnormalities.
- Relevant catheterization findings:
Coronary angiography via right radial artery access revealed a right dominant system, there was chronic total occlusion at mid LAD just after giving a large diagonal branch. There was no significant stenosis in other vessels and LAD was given collaterals from RCA, predominantly from the conus branch.