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.