Persistent Thebesian Sinusoids Presenting as Ischemic Heart Disease

Abstract

A 54-year-old man with no significant past medical history or modifiable cardiovascular risk factors was admitted with chest pains and palpitations. ECG revealed atrial fibrillation with fast ventricular response that reverted to sinus rhythm after intravenous administration of digoxin. His 12-hour troponin I level was marginally elevated (0.07 ng/mL; normal range <0.06 ng/mL). Subsequent serial 12-lead ECGs (Figure 1) demonstrated widespread dynamic ST-segment and T wave changes. The patient was treated for an acute coronary syndrome and became pain free on intravenous administration of glyceryl trinitrate and glycoprotein IIB/IIIA antagonist. Coronary angiography demonstrated pristine epicardial coronaries but a bizarre appearance of capillary blush draining into the left venticular cavity, during both left main stem and right coronary artery injection (Figure 2A and 2B and Movie I and II). In absence of any myocardial tumor, ventricular hypertrophy, or …