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Clinical introduction
A patient (aged mid-70s) was admitted following 4 days of chest pain and breathlessness. Investigations suggested a completed transmural anterior myocardial infarction (MI): ECG revealed anterior ST-elevation with anteroseptal Q waves (figure 1A); elevated troponin I (6.98 µg/L, normal range <0.1 µg/L); echocardiography demonstrated severe left ventricular systolic dysfunction with anteroseptal akinesia; and chest radiograph demonstrated pulmonary congestion. Treatment received included intravenous furosemide and standard secondary prevention medications including bisoprolol 2.5 mg once daily (initiated 48 hours after admission). Coronary angiography, on day 7, demonstrated severe stenoses in the mid-left anterior descending (LAD) and proximal obtuse marginal (OM) arteries (figure 1B).
(A) Admission ECG, (B) coronary angiography, (C) ECG morphology of unifocal premature ventricular complex and (D) telemetry recording showing polymorphic ventricular tachycardia and initiation (sweep speed 25 mm/s).
During angiography …
Footnotes
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Contributors JI prepared a draft of the manuscript. AMA prepared the images. AK and AMA revised the draft.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.