Cardiology>>>>>Ischaemic heart disease
Question 125#

A 41-year-old overweight heavy-smoker construction worker presented with chest pain while on the job associated with diaphoresis and dyspnea. In the field, no ECG could be obtained due to the extreme diaphoresis. In the ambulance, the patient developed hypotension, bradycardia, and subsequently asystole. Under cardiopulmonary resuscitation he was transferred to the cardiac catheterization laboratory and circulation was reestablished using extracorporeal membrane oxygenation. Subsequently, coronary angiography (Fig. below)

shows

a. Subtotal occlusion of the left main trunk
b. Aortic dissection
c. Anomalous origin of the left main trunk
d. Left main trunk stenosis equivalent (i.e., severe stenosis of the left anterior descending coronary artery and left circumflex)
e. Severe aortic stenosis

Correct Answer is A

Comment:

Subtotal occlusion of the left main trunk. Coronary angiography showed subtotal occlusion of the left main trunk and the lesion was treated with stenting. Ventriculography showed a severely reduced LVEF (15%) under a mechanical chest compression system. The patient did not recover and subsequently died.