Left Main Coronary Artery Disease
Cardiac Arrest Following Stress Echocardiography
A68-year-old man presented with epigastric burning associated with exercise. A stress echocardiogram was ordered. Baseline ECG (top panel, Rest) and echocardiographic images (bottom panel, Rest) were within normal limits. During stage I of the Bruce protocol, the patient’s blood pressure became unattainable. The test was terminated. The poststress ECG revealed ST-segment elevation and a new bifascicular block (top panel, Post Stress). Stress echocardiographic images obtained immediately after exercise showed diffuse systolic dysfunction. At end systole, marked dilatation of the septal, apical inferior, and high lateral segments was noted (bottom panel, Post Stress, arrows). Subsequently, bradycardia and pulseless electrical activity developed. The patient was resuscitated, and cardiac catheterization showed 80% stenosis in the left main coronary artery (top right, circled). The patient had uneventful coronary artery bypass graft surgery.
LV denotes left ventricle; RV, right ventricle; SAX, short-axis view; AP4, apical four-chamber view; AP2, apical two-chamber view; LM, left main coronary artery; LCX, left circumflex coronary artery; and LAD, left anterior descending coronary artery.
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.
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