ATYPICAL CASE OF UNSTABLE ANGINA WITH CLASSIC ELECTROCARDIOGRAM PRESENTATION OF LEFT MAIN CORONARY ARTERY DISEASE: A CASE REPORT AND A LITERATURE REVIEW

Merina Shrestha, Zhiquan Wang* and Bigesh Man Shakya

ABSTRACT

Non ST-Segment Elevation Acute Coronary Syndrome (NSTE ACS) patients with left main disease exhibit high risk of short and long term poor cardiovascular events. As compared to the clear indication for an emergent coronary angiography in ST-Segment Elevation Myocardial Infarction (STEMI) population, in NSTE ACS patients there is yet an unsureness with respect to favorable angiography timing. Due to acute Left Main Coronary Artery (LMCA) occlusion, severe hemodynamic instability commonly occurs leading to bad prognosis. Diagnosing the severity of coronary artery disease on presentation in NSTE ACS patients is helpful in guiding the treatment regarding the planning of coronary angiogram and revascularization. Therefore, the main aim of this case report is to support the previous evidence for predicting Left Main disease on the basis of classic Electrocardiogram (ECG) presentation with ST elevation in Lead aVR and favorable outcome achieved after timely done management with coronary angiography and Percutaneous Coronary Intervention in atypical Unstable Angina patients with normal lipid profile and cardiac markers.

Keywords: Unstable angina, left main disease, electrocardiogram, cardiac markers.