Volume 15, Number 5, September-October 2008

Occlusion of left main coronary artery diagnosed by computed tomography of the chest
Scot Garg, Christos Bourantas, Simon Thackray, Farqad Alamgir

A 55-year-old smoker with no significant past medical history was admitted following an episode of dyspnoea and intrascapular pain. Clinical examination was normal. His blood pressure (BP) was 80/40 mmHg and his electrocardiogram (ECG) showed a sinus tachycardia and right bundle branch block. A computed tomography (CT) scan of the chest excluded a pulmonary embolism and aortic dissection, and, although not a dedicated cardiac CT, suggested an occlusion of the left main coronary artery (LMCA) (figure 1). Echocardiography showed impaired left ventricular function with an akinetic anterior, inferior and lateral wall. An intra-aortic balloon pump (IABP) was inserted and coronary angiography was performed, which confirmed an occlusion of the LMCA (figure 2, panel B). This was pre-dilated, and then stented with a bare-metal stent (3.5 x 16 mm Liberté) producing an excellent final angiographic result (figure 2, panel D). Despite continued IABP support, he required ventilation for refractory pulmonary oedema, and died five days later.

Br J Cardiol 2008;15:269.

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