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Sailing in the complexity of the ‘shark-fin’ sign
  1. Antonio Landi,
  2. Anna Giulia Pavon,
  3. Marco Valgimigli
  1. Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Ticino, Switzerland
  1. Correspondence to Professor Marco Valgimigli, Cardiocentro Ticino, 6900 Lugano, Switzerland; marco.valgimigli{at}

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Clinical introduction

A woman in her 70s with no previous cardiovascular disease nor recent physical/emotional stress was admitted for transient anterolateral ST segment elevation myocardial infarction (MI). Urgent coronary angiography revealed an intermediate stenosis of proximal left anterior descending (LAD) artery and optical coherence tomography showed a plaque of multilayer appearance with no sign of plaque rupture, erosion or thrombus (figure 1A, online supplemental video 1). Left ventriculography revealed a typical apical ballooning (figure 1B, online supplemental video 2). The decision was taken not to treat this intermediate LAD stenosis. T2 mapping cardiac magnetic resonance (CMR) showed higher relaxation times in the anterior wall and in the apex (figure 1C) with no necrosis or scar (figure 1D). The following day, the patient experienced recurrent chest pain and ventricular fibrillation requiring electrical shocks. At that time, an electrocardiogram (EKG) revealed a transient appearance of …

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  • Contributors All authors were involved in patient care. AL and AGP were involved in preparing the manuscript and data collection. MV gave critical inputs in editing and reviewing the manuscript.

  • 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 MV reports grants and/or personal fees from Astra Zeneca, Terumo, Alvimedica/CID, Abbott Vascular, Daiichi Sankyo, Bayer, CoreFLOW, Idorsia Pharmaceuticals-Ltd, Universität Basel Department Klinische Forschung, Vifor, Bristol-Myers-Squib SA, Biotronik, Boston scientific, Medtronic, Vesalio, Novartis, Chiesi, PhaseBio, outside the submitted work. The other authors reported no relevant relationship to disclose.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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