Chest pain with diffuse coronary ischaemia

Area of Science:

• Cardiology
• Interventional Cardiology

Background:

• An 80-year-old male with hypertension and diabetes presented with new-onset ischemic chest pain.
• Physical examination revealed a soft systolic murmur, and ECG showed signs of diffuse subendocardial ischemia.

Observation:

• ECG findings suggested a critical left main or proximal LAD coronary lesion.
• Emergency coronary angiography was performed to evaluate for obstructive coronary artery disease.

Findings:

• Angiography identified tandem smooth stenoses in the proximal left circumflex (LCx) and left anterior descending (LAD) arteries.
• These stenoses were persistent and unresponsive to intracoronary nitrates, indicating a fixed obstructive process.

Implications:

• The findings underscore the importance of coronary angiography in diagnosing obstructive coronary artery disease in patients with ischemic symptoms.
• Prompt diagnosis and management of significant coronary stenoses are crucial for preventing adverse cardiovascular events.