Case Presentation

A 61-year-old male, was referred to our clinic for coronary angiography after a non-ST-segment elevation myocardial infarction (NSTEMI). The patient had a history of CAD and coronary stenting 3 years ago. Before NSTEMI he was on aspirin 1×100 mg, perindopril 1×5 mg, bisoprolol 1×5 mg and rosuvastatin 1×10 mg treatment orderly. On admission his chest pain was completely resolved. Vital signs were unremarkable with blood pressure of 130/80, pulse of 70 and respiratory rate of 14. Physical examination revealed normal heart sounds and clear lung fields. Electrocardiogram obtained upon arrival to the emergency department revealed a sinus rhythm without any sign of acute myocardial ischemia. Laboratory analysis confirmed myocardial infarction with elevated cardiac enzymes (Troponin I of 574 pg/mL, total creatine kinase of 168 units/L and CK-MB of 66 units/L). His medical treatment was managed and coronary angiogram was scheduled. The angiography showed significant ectasia and turbulent blood flow in the distal segment of left main coronary artery and proximal segmet of obtuse marginal 1 (Figure 1). There was 90% occlusion in the distal branch of obtuse marginal 1. This occlusion is thought to be related with the emboli due to slow flow that occur in the area of ectasia. Medical treatment was decided for the patient. He had no symptoms and he was discharged with the treatment of aspirin 1×300 mg, bisoprolol 1×5 mg, perindopril 1×5 mg, rosuvastatin 1×10 mg and clopidogrel 1×75 mg.