Santiago Saenz Ancira -

Description of case:71-year-old male with a past medical history of hypertension and diabetes. Presents to the emergency department with a one-week onset complaint of dizziness when standing and right ear pain. Patient related occasional chest “Tingling” associated with emotional stress.Initial 12 lead EKG showed new T wave inversions in V2, V3, V4 and V5 consistent with Wellens type B pattern(Image 1 B) . High sensitivity troponin remained plateau in 21 with consecutive assays. EKG however presented interval progression, as the T wave inversions in V2 and V3 became biphasic T waves consistent with Wellens type A pattern.(Image 1 A)Transthoracic echocardiogram showed akinesis of the anterior and anteroseptal wall (Video 1-2). Due to the EKG and Transthoracic echocardiogram findings consistent with compromise of the Left Anterior Descending artery territory, the patient underwent coronary angiography.Proximal to mid Left Anterior Descending Artery 90% stenosis was identified. The lesion was successfully reduced to 0% and a drug eluting stent was deployed.(Image 2 A through C)Throughout admission the patient remained chest pain free and never related clear symptoms of heart failure.