Coronary angioscopy revealing ruptured plaque and thrombus causing acute anterior myocardial infarction with a subsequent acute inferior myocardial infarction — a case report

Abstract

We report a unique case that suggests that a thrombotic coronary occlusion was caused by local plaque rupture in the left anterior descending coronary artery (LAD), with subsequent thrombotic occlusion in the right coronary artery (RCA), and presented with simultaneous double coronary artery occlusions. ST-segment elevations in the precordial leads and cardiac tamponade were observed first, followed by ST-segment elevations in the inferior leads. Emergency coronary intervention for the RCA lesion resulted in further ST-segment elevation, suggesting an acute inferior infarction. A left ventricular rupture was found in the anterolateral wall, consistent with acute anterior infarction. Angioscopy one month later revealed the presence of ruptured plaque with thrombus, in both the LAD and the RCA.