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Chest pain and diaphoresis developed in an 81-year-old woman with chronic renal insufficiency and hypertension. Although the chest pain resolved, she saw her primary care physician three days later because of profound fatigue. She had a loud holosystolic murmur on physical examination. A 12-lead electrocardiogram demonstrated ST-segment elevation and Q waves in leads II, III, and aVF. The creatine kinase level was 274 U per liter, with an MB fraction of 23 U per liter, and the cardiac troponin I level was more than 50 ng per milliliter. Cardiac catheterization revealed critical single-vessel disease of the right coronary artery without . . . [Full Text of this Article] |
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