Total Left Main Occlusion ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock and Delayed Sinus Node Dysfunction.
Ibrahim Hasan, Nebras Shafeek Hasan, Moied Al Sakan et al.
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Case in brief
A 58-year-old man presented with severe chest pain due to an extensive anterolateral STEMI caused by total occlusion of the left main coronary artery. He developed cardiogenic shock and required intubation and urgent percutaneous coronary intervention. Despite successful revascularization, he experienced delayed sinus node dysfunction, leading to a brief syncopal episode and the need for a pacemaker. His left ventricular ejection fraction improved from less than 30% to 40-45% before discharge.
What made this case unusual
The case featured an anomalous origin of a small circumflex artery from the right coronary artery, which is a rare anatomical variant.
Diagnostic / clinical pearl
Clinicians should be vigilant for delayed conduction complications, such as sinus node dysfunction, following acute myocardial infarction, especially in cases of severe cardiogenic shock.
Why it matters
This case underscores the importance of rapid revascularization and hemodynamic support in managing total left main coronary artery occlusion, which can significantly impact patient outcomes.