Primary Angioplasty

A 36 year old male presented at the accident and emergency at 16:30 hours.

He was a labourer who was digging a trench when he developed a sudden onset of chest pain, he was sweating profusely, looked grey and was vomiting. The pain had only started 30 minutes previously.

BP was 152/95 

He had no family history, and the only risk factor we could identify was the fact that he was a smoker of 20 a day  

What are your ECG findings?

Would you thrombolyse?   

Technically this ECG does not meet the criteria for thrombolysis, despite having these “hyperacute T’s”, there is very little in the way of ST elevation. However, we did feel that he was likely to be having an MI. Rapid transfer to the tertiary interventional site for angiogram was arranged and within 30 minutes of arrival in A&E he was in theatre. By the time he had arrived at the tertiary site his ECG looked like this:

Angiogram 1 shows total occlusion of his left anterior descending artery, consistent with the ECG findings of an Anterior MI. Fig 2 shows the artery after angioplasty (from a reverse angle), while Fig 3, shows the artery after stent deployment.

Left Main stem 

descending artery

Post angioplasty

fig 2

Guide wire can be seen inside artery.

Post stent

fig 3

This young man was very lucky to pull through. He had a VF arrest while having the stent fitted and ended up on a balloon pump afterwards. 

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