Abstract
A 76-year-old woman sought treatment for chest pain radiating down both arms, which was unrelieved by sublingual nitroglycerine. Her medical history included hypertension, exertional angina, and hyperlipidemia. Her daily medications included metoprolol, lovastatin, hydrochlorothiazide, aspirin, and occasional sublingual nitroglycerine. Electrocardiogram findings were consistent with acute anterior myocardial infarction. The patient began receiving intravenous nitroglycerine and heparin and was given streptokinase. This did not ameliorate her symptoms or electrocardiogram findings, and she was sent for cardiac catheterization, which showed significant stenoses of the left anterior descending and right circumflex coronary arteries. Percutaneous transcardiac angioplasty was attempted but did not relieve her stenoses. Her clinical condition improved, however, and she was transferred to the intensive care unit.
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