Abstract
A 69-year-old man with a 2-day history of chest pain was admitted to our hospital. His ECG was consistent with acute coronary syndrome (Figure 1A) and troponin I was elevated (>50 ng/mL). Coronary angiography showed a totally occluded circumflex with extensive intraluminal thrombus but no other obstructive disease (Figure 1B). Because the chest pain had completely resolved and this was a late-presentation myocardial infarction, management was medical. Echocardiography on day 6 showed inferolateral wall akinesis (Figure 1C and 1D) but preserved overall left ventricular (LV) function. Cardiovascular magnetic resonance (CMR) imaging 24 hours later to assess for viability showed an area of extreme thinning in the inferolateral wall due to myocardial rupture contained by overlying pericardium (Figure 1E and 1F, arrow, and online-only Data Supplement Movie I). Images acquired early after gadolinium contrast showed a layer of thrombus overlying the area of rupture (Figure 1G, arrow) and extensive no-reflow within the inferolateral wall (Figure 1G, arrowheads). Review of the echo images revealed an area in the inferolateral wall that could be …
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