A 31 year old male presented to A&E with atypical chest pain associated with a markedly elevated troponin, CK, white cell count and RBBB with some lateral ST elevation on his ECG. A provisional diagnosis of myopericarditis was made however following admission due to ongoing pain and echocadiographic findings demonstrating severe LV impairment, he was taken to the cardiac catheterisation laboratory for angiography, at 01.00am.
The first angiogram demonstrated a large saddle thrombus in the distal LMCA involving both LAD and Cx ostia. PCI was initially undertaken by aspirating thrombus and gentle POBA of the LAD alone with the patient commenced on abciximab (Reopro). Repeat angiography 12h later revealed no change however the patient deteriorated and underwent PCI to both LAD and Cx in an attempt to resolve the deteriorating clinical status.
Discussion on the possible aetiologies and debate of the management options is discussed in this case.