Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 28-year-old firefighter man who only had dyslipidemia as a coronary risk factor. In December 2016, he felt the first chest compressive feeling persisted for a few minutes during running, but since then the same symptoms were repeated frequently, the duration lasted longer, and he visited a nearby doctor. Holter Electrocardiogram showed a horizontal type ST segment depression at the time of exercise, he was introduced to our hospital on January 4, 2016 on suspicion of angina pectoris.
Relevant test results prior to catheterization
Coronary artery angiography was performed by diagnosis of unstable angina because of adenocarcinomas, echocardiograms. The blood tests showed no obvious abnormalities, but coronary artery CT examination showed stenosis with plaque in the left anterior descending branches.
Relevant catheterization findings
Due to 90% of stenosis accompanied by difference in density of contrast in the left anterior descending line #7, the thrombus or dissection was suspected and Optical Frequency Domain Imaging was performed. He recognized irregularities and eccentric plaques in the lumen of the arterial wall and doubted the involvement of natural coronary artery dissection. #7 was judged as a responsible lesion, and Xience Xpedition 3 × 18 mm, a drug-eluting stent, was placed and improvement was confirmed at 0% TIMI-3.
We judged #7 as a responsible lesion, At the time of passing through the wire, we confirmed the contrast delay and the ST elevation and confirmed the blocking of #7, passing through the false lumen, so we confirmed the true lumen passage by the advanced contrast. Xience Xpedition 3 × 18 mm, a drug-eluting stent, was placed and improvement was confirmed at 0% TIMI-3. Postoperative complications were not observed, and emergence of Q wave and elevation of myocardial escape enzyme were not observed, so he was discharged. After six months follow-up, coronary angiography performed, no stenosis was found in the #7 stent and no other new lesions were observed.
For that reason, we are continuing to treat the outpatient including secondary prevention management.We learned how angina symptoms are useful for diagnosis by experiencing cases of unstable angina with juvenile onset with few coronary risk factors.