Saturday, September 23, 2023
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Professor of Medicine, Harvard Medical School; Executive Director of Interventional Cardiovascular Programs, Brigham and Women’s Hospital Heart and Vascular Center, Boston, Massachusetts
Professor of Medicine; Director, Advanced Heart Failure Treatment Program, University of California, San Diego, La Jolla, California
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As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.
Professor of Medicine, Harvard Medical School; Executive Director of Interventional Cardiovascular Programs, Brigham and Women’s Hospital Heart and Vascular Center, Boston, Massachusetts
Professor of Medicine; Director, Advanced Heart Failure Treatment Program, University of California, San Diego, La Jolla, California
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CME / ABIM MOC / CE Released: 6/20/2016
Valid for credit through: 6/20/2017, 11:59 PM EST
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MT, a 68-year-old white man, was brought to the emergency department by his wife after he experienced chest discomfort that
did not resolve after 6 to 7 hours. He initially thought that his symptoms were due to indigestion and heartburn and was thus
reluctant to seek medical help. His medical history is significant for hyperlipidemia (treated with atorvastatin 10 mg/d),
mild hypertension (controlled on a salt-restricted diet without medical therapy), and type 2 diabetes mellitus (diet controlled
without medical therapy).
An electrocardiogram, obtained within 10 minutes of arrival at the emergency department, showed ST elevation of 3 to 4 mm
anteriorly. On coronary angiography, performed within 58 minutes of presentation, a completely occluded proximal left anterior
descending (LAD) artery and 40%, 50%, and 50% stenoses of the proximal, middle, and distal portions of the right coronary
artery (RCA), respectively, were noted. A left ventriculogram revealed akinesia of the anterior wall, anterior septum, and
left ventricular (LV) apex, with an estimated LV ejection fraction (LVEF) of 25%.
MT underwent primary percutaneous coronary intervention (PCI) with implantation of a second-generation drug-eluting stent, which successfully restored patency of the LAD artery. On day 2 after PCI, he seemed to be doing relatively well, with no overt ischemic symptoms on ambulation. Occasional premature ventricular contractions (PVCs) were noted on telemetry, without evidence of sustained ventricular tachycardia (VT). His LVEF was 30% as determined by echocardiography.
