Case 160

Abstract

A 57-year-old caucasian male has a history of tobacco abuse (stopped 1 year ago), hyperlipidemia (under good control with atorvastatin and omega-3 fish oil), hypertension (managed with trandolapril and indepamide), and angina (treated with carvedilol, isosorbide, and aspirin). His anginal history dates to the onset of exertional angina walking up hill to work approximately 8 months ago. A stress echocardiogram study suggested single vessel right coronary artery (RCA) disease and his symptoms were managed medically very successfully for 7 months with carvedilol. Over the past 3 weeks his exertional angina increased despite the addition of isosorbide. The patient was admitted to the hospital following one episode of rest pain that awakened him from sleep, associated with new T wave inversions anteriorly without any troponin or CK enzyme rise. Coronary angiography was performed and revealed a long left anterior descending (LAD) stenosis with an irregular filling defect plus an 85% RCA stenosis. Both stenotic regions were heavily calcified. The patient underwent coronary artery bypass surgery with a left internal mammary artery graft to the LAD and a saphenous vein graft to the RCA. © Springer-Verlag London Limited 2011.