Abstract
A 38-year-old Chinese man presented with chest pain associated with loss of consciousness and a witnessed generalized seizure. An electrocardiogram (ECG) done soon after the seizure showed a junctional rhythm and anteroseptal ST elevation of 2 mm with marked inferolateral ST depression of 3 mm. Peak creatinine kinase (CK) was 870 U/l with an MB fraction of 43 U/l. Exercise treadmill test was abnormal with 3 mm inferolateral ST depression at peak exercise. A computed tomographic scan of the head and electroencephalogram were normal. Coronary angiography showed 75% narrowing of the left main coronary artery with normal left anterior descending and circumflex coronary arteries. There was ventricularization of the pressure tracing and the patient experienced chest pain with ST segment depression in leads II and Vl which were the monitoring leads. The blood pressure, however, remained normal. The luminal narrowing increased to 90% (Fig. 1) following the second injection of contrast. Buccal nitroglycerine spray was administered with good symptomatic relief, and reinjection
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