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VIDEO 236-5: A 60-year-old female presented with intermittent chest pain of 3 days in duration but was pain free at the time of assessment in the emergency room.

From: Harrison's Principles of Internal Medicine, 20e

Admission electrocardiogram (ECG) demonstrated T-wave inversion in the anterior precordial lead, but cardiac enzymes were normal. A resting cardiac magnetic resonance (CMR) study reviewed a large area of anteroseptal hypokinesia (left picture, region of hypokinesia shown by the red arrows), matching with a large resting perfusion defect (middle picture, perfusion defect shown by the blue arrows). Late gadolinium enhancement (LGE) imaging (right picture), however, did not show any enhancement to indicate any infarction in the anteroseptal wall, suggesting that the hypocontractile and hypoperfused anteroseptal wall was viable. Urgent coronary angiography demonstrated an acute thrombus in the mid left anterior descending coronary artery, which required coronary stenting. This case represents an example of acute coronary syndrome with hibernating but viable myocardium in the anteroseptal wall. The anteroseptal wall recovered contractile function when reassessed 6 months later.

11 secs
Author(s) Marcelo F. Di Carli, Raymond Y. Kwong, Scott D. Solomon
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