Author: Jean-François Paul, MD, Plessis-Robinson, France
Body Region: Cardiovascular
1. Patient Presentation
- A 46-year-old man had an acute inferior myocardial infarction after physical exercise.
- There was no evidence of heart failure. Electrocardiography showed a 3-mm ST-T segment
elevation with Q waves in leads D2, D3, and VF and a 3-mm depression in leads V2-V4.
- Immediate coronary angiography evidenced a tight stenosis with distal slow flow in the right
coronary artery. Percutaneous transluminal coronary angioplasty, with implantation of 2 stents, was
successfully performed and normal flow was restored. Post-procedure electrocardiography showed an
isoelectric ST-T segment in leads D2, D3, and VF.
- Maximal creatine kinase elevation was 500 IU, 12 hours after the onset of clinical symptoms.
Subsequent cardiac auscultation uncovered a loud holosystolic murmur. - Color-coded Doppler echocardiography demonstrated a ventricular septal defect with a
left-to-right shunt. - ECG-gated contrast-enhanced 16-slice CT was performed for further evaluation.