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Myocardial infarction caused by distal embolisation of a ruptured left main plaque
  1. W J van Gaal,
  2. N West,
  3. A P Banning
  1. william@vangaal.org

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A 54-year-old man presented with a non-ST elevation myocardial infarction. Coronary angiography demonstrated a hazy appearance of the distal left main (LM) stem, and a thrombotic subtotal occlusion of the distal left anterior descending (LAD) artery with TIMI grade 1 flow (lower left panel, A, B). He was discharged following conservative management with antiplatelet treatment; however, he experienced ongoing exertional angina. Repeat angiography four weeks later demonstrated an ulcerated plaque in the distal LM stem, and a patent LAD with normal antegrade flow. There was …

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