The first acute myocardial infarction (MI) of an elderly male was determined through angiography to be due to an infarct of the circumflex artery. The angiogram also revealed chronic occlusion and diffuse disease of the left anterior descending artery (LAD). This had been compensated for by collateral circulation from the right coronary artery. Since the patient had no prior history of coronary artery disease, the chronic and collateralized disease of the LAD was pre sumed to be stable and this artery was not treated. Due to a history of aspirin intolerance a bare metal stent was im planted in the circumflex artery. Within hours after stenting the patient had a second acute MI. Despite no change in the angiogram, the EKG suggested that the LAD was the source of the second MI. Indeed, a drug-eluting stent implanted in the LAD resolved the patient’s signs and symptoms and he was discharged with a favorable outcome. The surprising second MI and the inconsistent stenting illustrate that when the unexpected occurs, there is no substitute for the judg ment of a skilled clinician.
KeywordsClinical MedicineAngiographyAngioplastyBare Metal StentDrug-Eluting StentCollateral CirculationAspirin IntoleranceEmotional Stress in Hospitalized Heart PatientsTeam Communication
G. M. Howard-Alpe, J. de Bono, L. Hudsmith, W. P. Orr, P. Foex and J. W. Sear, “Coronary Artery Stents and Non-Cardiac Surgery,” British Journal of Anaesthesia, Vol. 98, No. 5, 2007, pp. 560-574. doi:10.1093/bja/aem089
G. A. Nuttall, M. J. Brown, J. W. Stombaugh, W. John, P. B. Michon, M. F. G. Ha-thaway, K. C. Lindeen, A. C. Hanson, D. R. Schroeder, R. Darrell, W. C. Oliver, D. R. Holmes and C. S. Rihal, “Time and Cardiac Risk of Surgery after Baremetal Stent Percutaneous Coronary Intervention,” Anesthesiology, Vol. 109, No. 4, 2008, pp. 588-595.
J. A. Rabbitts, G. A. Nuttall, M. J. Brown, A. C. Hanson, W. C. Oliver, D. R. Holmes and R. Charanjit, “Cardiac Risk of Noncardiac Surgery after Percutaneous Coronary Intervention with Drug-Eluting Stents,” Anesthesiology, Vol. 109, No. 4, 2008, pp. 596-604.
H. P. Brunner-La Rocca, C. Kaiser, A. Bernheim, M. J. Zellweger, R. Jeger, P. T. Buser, S. Osswld and M. Pfisterer, “Cost-Effectiveness of Drug-Eluting Stents in Patients at High or Low Risk of Major Cardiac Events in the Basel Stent KostenEffekti-vit?ts Trial (BASKET): An 18-Month Analysis,” Lancet, Vol. 370, No. 9598, 2007, pp. 1552 - 1559. doi:10.1016/S0140-6736(07)61660-2
I. Iakovou, T. Schmidt, E. Bonizzoni, L. Ge, G. M. Sangiorgi, G. Stan-kovic, F. Airoldi, A. Chieffo, M. Montorfano, M. Cartino, I. Michev, N. Corvaja, C. Briguori, U. Gerckens, E. Grube and A. Colombo, “Incidence, Predictors, and Outcome of Thrombosis After Successful Implantation of Drug-Eluting Stents,” Journal of American Medical Assocition, Vol. 293, No. 17, 2005, pp. 2126-2130. doi:10.1001/jama.293.17.2126
M. N. Babaputte, L. Joseph, P. Bélisle, J. M. Brophy and M. J. Eisenberg, “A Hierarchical Bayesian Meta-Analysis of Randomised Clinical Trials of Drug-Eluting Stents,” Lancet, Vol. 364, No. 9434, 2004, pp. 583-591. doi:10.1016/S0140-6736(04)16850-5
J. Schofer, M. Schlüter, A. H. Gershlick, W. Wijns, E. Garcia, E. Schampaert, and G. Breithardt, “Sirolimus-Eluting Stents for Treatment of Patients with Long Atherosclerotic Lesions in Small Coronary Arteries: Double-Blind, Randomised Controlled Trial (E-SIRIUS),” Lancet, Vol. 362, No. 9390, 2003, pp. 1093-1099. doi:10.1016/S0140-6736(03)14462-5
H. Schühlen, M. Hadamitzky, H. Walter, K. Ulm, and A. Sch?mig, “Major Benefit from Antiplatelet Therapy for Patients at High Risk for Adverse Cardiac Events after Coronary Palmaz-Schatz Stent Placement,” Circulation, Vol. 95, No. 8, 1997, pp. 2015-2021. doi:10.1161/01.CIR.95.8.2015
G. Steffenino, B. Meier, L. Finci, V. Velebit, L. von Segesser, B. Faidutti and W. Rutishauser, “Acute Complications of Elective Coronary Angioplasty: A Review of 500 Consecutive Procedures,” British Heart Journal, Vol. 59, No. 2, 1988, pp.151-158. doi:10.1136/hrt.59.2.151
W. S. Weintraub, C. L. Brown, H. A. Liberman, D. C. Morris, J. S. Douglas Jr. and S. B. King III, “Effect of Restenosis at One Previously Dilated Coronary Site on the Probability of Restenosis at Another Previously Dilated Coronary Site,” American Journal of Cardiology, Vol. 72, No. 15, 1993, pp. 1107-1113. doi:10.1016/0002-9149(93)90977-K
G. L. Kaluza, J. Joseph, J. R. Lee, M. E. Raizner and A. E. Raizner, “Catastrophic Outcomes on Noncardiac Surgery Soon after Coronary Stenting,” Journal of the American College of Cardiology, Vol. 35, No. 5, 2000, pp. 1288-1294. doi:10.1016/S0735-1097(00)00521-0
J. J. Badimon, A. F. Ortiz, B. Meyer, A. Mailhac, J. T. Fallon, E. Falk, L. Badimon, J. H. Chesebro and V. Fuster, “Different Response to Balloon Angioplasty of Carotid and Coronary Arteries: Effects on Acute Platelet Deposition and Intimal Thickening,” Atherosclerosis Vol. 140, No. 2, 1998, pp. 307-314. doi:10.1016/S0021-9150(98)00134-8
J. B. Foley, R. I. Brown and I. M. Penn, “Thrombosis and Restenosis after Stenting in Failed Angioplasty: Comparison with Elective Stenting,” American Heart Journal, Vol. 128, No. 1, 1994, pp. 12-20. doi:10.1016/0002-8703(94)90004-3
C. Indolfi, F. Piscione, A. Rapacciuolo, G. Esposito, N. Esposito, R. Ceravolo, E. Di Lorenzo, A. Maione, M. Condorelli and M. Chiariello, “Coronary Artery Vasoconstriction after Successful Single Angioplasty of the Left Anterior Descending Artery,” American Heart Journal, Vol. 128, No. 5, 1994, pp. 858-864. doi:10.1016/0002-8703(94)90580-0
V. P. Moles, F. Chappuis, P. Urban, F. De La Serna, A. K. Pande and B. Meier, “Aortic Dissection as Complication of Percutaneous Transluminal Coronary Angioplasty,” Catheterization and Cardiovascular Diagnosis, Vol. 26, No. 1, 1992, pp. 8-11. doi:10.1002/ccd.1810260103
H. Nassar, Y. Hasin and M. S. Gotsman, “Cardiac Tamponade Following Coronary Arterial Reupture During Coronary An-gioplasty,” Catheterization and Cardiovascular Diagnosis, Vol. 2, No. 3, 1991, pp. 177-179. doi:10.1002/ccd.1810230306
R. H. Graf and M. S. Verani, “Left Main Coronary Artery Stenosis: A Possible Complication of Transluminal Coronary Angioplasty,” Catheterization and Cardiovascular Diagnosis, Vol. 10, No. 2, 1984, pp. 163-166. doi:10.1002/ccd.1810100207
D. Kimbiris, A. S. Iskandrian, I. Goel, C. E. Bemis, L. Gehl, J. Owens and B. L. Segal, “Transluminal Coronary Angioplasty Complicated by Coronary Artery Perforation,” Catheterization and Cardiovascular Diagnosis, Vol. 8, No. 5, 1982, pp. 481-487.doi:10.1002/ccd.1810080507
E. Quattromani, A. Aldeen, W. Mosloey II and D. Courtney, “A Case Series and Review of Takotsubo Cardiomyopathy: Does Stress Really Cause the Stress Cardiomyopathy? Flying-Machine,” International Journal of Clinical Medicine, Vol. 2, No. 1, 2011, pp. 28-34. doi:10.4236/ijcm.2011.21007
P. M. S. Carvalho, J. H. Lima, J. B. Cunha, P. G. D. Dias, J. G. D. Vieira and J. M. N. Costa, “Tako-Tsubo Cardiomyopathy—The Role of Physical and Emotional Stressors: Two Case Reports,” International Journal of Clinical Medicine, Vol. 3, No. 2, 2012, pp. 145-150. doi:10.4236/ijcm.2012.32029
A. Rosengren, S. Hawken, S. ?unpuu, K. Sliwa, M. Zubaid, W. A. Al-mahmeed, K. N. Blackett, C. Sitthi-Amorn, H. Sato and S. Yusuf, “Association of Psychological Risk Factors with Risk of Acute Myocradial Infarction in 11,119 Cases and 13,648 Controls from 52 Countries (The INTERHEART Study): Case-Control Study,” Lancet, Vol. 364, No. 9438, 2004, pp. 953-962. doi:10.1016/S0140-6736(04)17019-0
W. Jiang, M. Babyak, D. S. Krantz, R. A. Waugh, R. E. Coleman, M. M. Hanson, D. J. Frid, S. McNulty, J. J. Morris, C. M. O’Connor and J. A. Blumenthal, “Mental Stress—Induced Myocardial Ischemia and Cardiac Events,” Journal of American Medical Association, Vol. 275, No. 21, 1996, pp. 1651-1656. doi:10.1001/jama.275.21.1651
M. A. Mittleman, M. Maclure, J. B. Sherwood, R. P. Mulry, G. H. Tofler, S. C. Jacobs, R. Friedman, H. Benson and J. E. Muller, “Triggering of Acute Myocardial Infarction Onset by Episodes of Anger,” Circulation, Vol. 92, No. 7, 1995, pp. 1720-1725. doi:10.1161/01.CIR.92.7.1720
N. Frasure-Smith, F. Lespérance and M. Talajic, “The Impact of Negative Emotions on Prognosis Following Myocardial Infarction: Is it More Than Depression?” Health Psychology, Vol. 14, No. 5, 1995, pp. 388-398. doi:10.1037/0278-6133.14.5.388