Simultaneous Plaque Rupture in Two Coronary Arteries Presenting as Acute Coronary Syndrome

Area of Science:

• Cardiology
• Interventional Cardiology
• Diagnostic Imaging

Background:

• Chest pain, or angina, is a common symptom requiring prompt diagnosis.
• Electrocardiography (ECG) is a crucial initial tool for assessing cardiac events.
• Identifying the specific blocked coronary artery (culprit vessel) is vital for timely treatment, especially with primary percutaneous coronary intervention (PCI).

Observation:

• A 45-year-old male presented with symptoms of angina.
• Electrocardiogram (ECG) revealed transient complete heart block (CHB) and T-wave inversions in anterior and inferior leads.
• Coronary angiography demonstrated thrombotic lesions in the left anterior descending (LAD), left circumflex (LCX), and obtuse marginal (OM) arteries.

Findings:

• The presence of thrombotic lesions in multiple coronary arteries (LAD, LCX, OM) made it challenging to definitively identify the single culprit vessel based on initial ECG findings.
• ECG findings, while indicative of ischemia, were not specific enough to pinpoint the exact location of the occlusive lesion.

Implications:

• Complex coronary artery disease with multiple thrombotic lesions can impede rapid culprit vessel identification.
• Accurate identification of the culprit vessel is essential for guiding successful primary PCI and improving patient outcomes.
• Advanced imaging like coronary angiography is critical when ECG is equivocal in cases of multi-vessel disease.