by Sanket
Borgaonkar, MD, and Yochai Birnbaum, MD, FACC
A 59-year-old woman with hypertension,
hyperlipidemia, and gastroesophageal reflux reported exertional angina that
resolved with rest and nitroglycerin. Nuclear stress test results revealed a
small, reversible inferior-wall defect and a left ventricular ejection fraction
(LVEF) of 0.67. A coronary angiogram showed diffuse 3-vessel disease. The
patient underwent elective 4-vessel coronary artery bypass grafting (CABG) with
no complications and was extubated the next day. On postoperative day 2, a
routine electrocardiogram (ECG) showed an rSr′ pattern in leads V1 and
V2, and ST-segment elevation (STE) in leads V2 through V4
(Fig. 1).
