(Circulation. 1998;98:1348.)
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Angiographic and Ultrasonic Evidence of Plaque Rupture Causing Myocardial Infarction
Hani S. Al-Sergani, MBBS;
Philip J. Fitzpatrick, MD;
; Sergio Waxman, MD
From the Cardiovascular Division, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, Mass.
Correspondence to Sergio Waxman, MD, Cardiovascular Division, Beth Israel Deaconess Medical Center, One Deaconess Rd, Boston, MA 02215. E-mail swaxman{at}bidmc.harvard.edu
A
60-year-old man with no prior cardiac
history presented to the emergency room with 1.5 hours of
substernal chest pain. An ECG revealed ST-segment elevation in leads
V2 to V6. Acute
anterolateral myocardial infarction was diagnosed, and
thrombolytic therapy in the form of tPA was
administered, with resolution of the chest pain and ST-segment
elevation. Because of postinfarct angina, he underwent urgent cardiac
catheterization. Coronary angiography (Figure
,
top) revealed a focal linear intraluminal filling defect in the middle
portion of the left anterior descending coronary artery
(arrow). Intravascular ultrasound of the corresponding area (bottom)
demonstrated the presence of an eccentric lesion with a hypoechoic
crescentic area within the plaque (large arrow) and an overlying cap
(small arrow). The hypoechoic area within the lesion partially filled
with contrast material and probably represents the site of a
lipid pool in a plaque that ruptured. On the basis of the ultrasound
findings, the angiogram showed the eccentric lesion filling with
contrast material beneath a fibrous cap. A 4.0-mm intracoronary
Palmaz-Schatz stent was placed successfully, with no residual
stenosis. The patient had a full recovery and was discharged
home on day 5 of hospitalization.
Footnotes
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
