60 year old Female
History of Present Illness (HPI):
- Hx of hypertension, hyperlipidemia, diabetes and angina.
- Angina unresponsive to beta blocker therapy.
- Did not tolerate nitrates or other anti-anginals.
- Non-insulin dependent diabetes; takes oral medication.
- Presented with shortness of breath and chest pain.
- Myocardial perfusion imaging (MPI) study demonstrated normal ejection fraction (EF) and reversible lateral wall ischemia.
- Chronic atrial fibrillation (AF); taking warfarin therapy.
- Cardiac catheterization revealed:
- Normal left ventricular (LV) function - EF of 55%
- Normal left main (LM) and right coronary arteries (RCA).
- 85% occlusion, about 1 cm in length, in proximal circumflex artery.
- 35% occlusion more diffuse in several views, eccentric in the left anterior descending artery (LAD); about a 20-mm lesion.
- Decision was made to medically optimize patient.