A Unique Case Report of Complete Left Main Coronary Artery Occlusion in a 24-Year-Old Male

J INVASIVE CARDIOL 2020;32(5):E140.

Key words: coronary angiogram, electrocardiogram, left main coronary artery, occlusion

The left main coronary artery (LMCA) supplies 75% to 100% of the left ventricle depending on the coronary dominance. Critical LMCA stenosis puts patients at high risk of cardiovascular events because of the extent of jeopardized myocardium. LMCA occlusion is extremely rare under the age of 25 years. It commonly manifests as myocardial infarction with cardiogenic shock and fatal arrhythmias. Prompt diagnosis and early revascularization are essential for survival. 

We report the case of a 24-year-old male who presented to hospital following syncope with electrocardiographic changes  and was found to have LMCA occlusion requiring emergent coronary artery bypass grafting. His only risk factor for vascular disease was smoking 1 or 2 cigarettes a day. The electrocardiogram showed diffuse ST depression across all leads, except aVR, for which there was ST elevation (Figure 1). He was taken for urgent coronary angiogram, which showed occluded LMCA that filled retrogradely from the right coronary artery (Figure 2 and Video 1). He proceeded to emergent coronary artery bypass surgery. Postoperative course was unremarkable and the patient was discharged 12 days later.

From the Gold Coast University Hospital Radiology Department, Gold Coast University Hospital Cardiology Department, and Griffith University School of Medicine, Gold Coast, Southport QLD, Australia.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. 

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted September 17, 2019.

Address for correspondence: Paul Heyworth, MBBS, Gold Coast University Hospital, 1 Hospital Blvd, Southport QLD 4215, Australia. Email: Heyworth.paul@gmail.com