'Only the good...'

摘要

A 50 year old man presented with retrosternal burning while walking up a slight incline, which resolved on resting. He had a family history of coronary artery disease and was taking drugs for hypertension and hyperlipidaemia. Five years earlier he had had angioplasty to the marginal artery and a bare metal stent had been inserted. On this occasion physical examination was unremarkable and a resting echocardiogram was normal. However, a stress echocardiogram showed ST depression in the lateral leads that appeared at stage 3 of the Bruce protocol and continued for nine minutes in recovery, as well as reversible apical hypokinesia. Coronary angiography showed a patent stent in the marginal artery and a 95% stenosis of the left anterior descending artery. This was successfully dilated and a bare metal stent inserted.