Living on a Thread: A Case of Critical Left Main Coronary Artery Disease With an Unusual Presentation

The left main disease is significant stenosis of the left coronary artery, which is responsible of supplying blood to a major portion of the left ventricle. In this report, we describe a unique case of critical left main disease with a special clinical presentation. A 66-year-old male with insignificant past medical history presented with dyspepsia. Patient presented twice to the emergency department seeking for help for his persistent complaint. During his second visit, patient was diagnosed with type one myocardial infarction and underwent coronary angiography which showed 90% stenosis in the left main coronary artery. Patient underwent successful coronary artery bypass grafting and was sent home. This case is a unique representation of type 1 myocardial infarction as the peak troponin I level does not correlate with the extent of the myocardium being jeopardized. A big portion of the heart is at risk of injury with the 90% stenosis found in this patient's left main coronary artery, yet the peak troponin I level is minimum. This report provides a possible explanation of the discrepancy between the peak troponin I level and the extent of the myocardium being jeopardized and describes a common yet easily missed clinical presentation of acute coronary syndrome. Left main disease is a relatively uncommon presentation of acute coronary syndrome, with potentially serious detrimental consequences. Discrepancies do occur among patients of critical left main disease, and promptly diagnosing and managing is of great importance.