Persistent angina without persistent ST-segment elevation: do not forget a myocardial infarction with acute occlusion of a coronary artery
Aldomà-Balasch, Albina; Rivera-Aguilar, Pedro Kristian; Zielonka, Marta Zofia
ABSTRACT
Case report: a 57-year-old man consulted for chest pain suggestive of angina. The electrocardiogram (ECG) showed a right bundle branch block (RBBB), not present in previous ECGs, with secondary abnormalities of repolarization without meeting the criteria for ischemia. Due to persistent angina despite treatment, an emergent coronary angiography was performed, which showed an acute thrombotic occlusion of the right coronary artery (RCA) with good collateral circulation (CC) from the left coronary tree, which did not present significant stenosis. After reperfusion, angina progressively disappeared, and RBBB resolved. The infarct size was smaller than expected, as well as the poor electrocardiographic expressiveness, due to the good heterocoronary CC that was observed in the infarcted territory.
Conclusion: myocardial infarction with acute occlusion of a coronary artery must be kept in mind in patients with persistent angina despite treatment, and the ECG does not show the typical abnormalities.
