An acute ST-elevation myocardial infarction (STEMI) followed by reinfarction within a short period of time is typically due to stent thrombosis. However, a STEMI caused by occlusion of one vessel followed by a repeat infarction due to occlusion of a different vessel which was seemingly innocent a few hours earlier is extremely rare. We present the case of a 61-year-old male with a past medical history of prediabetes, hyperlipidemia, tobacco use, and gastroesophageal reflux disease who presented to the emergency department with complaints of chest pain. His initial electrocardiogram (EKG) revealed ST elevation in leads II, III and aVF with reciprocal changes in leads I and aVL. He promptly underwent cardiac catheterization and had percutaneous coronary intervention with placement of two drug-eluting stents (DES) in the right coronary artery (RCA). At that time coronary angiography revealed 50% stenosis of the left anterior descending (LAD) artery and 60% stenosis of the second diagonal branch artery. Shortly after the procedure he was asymptomatic, and the post procedure EKG demonstrated resolution of the ST elevations. However, within 2 hours he developed chest pain and was found to have new ST elevations in the anterolateral leads. Repeat cardiac catheterization revealed patent RCA stents with subtotal occlusion of the LAD and another DES was placed. After the second procedure the patient remained hemodynamically stable, EKG changes resolved, and he was kept on eptifibatide infusion for 18 hours after which he was switched to dual antiplatelet therapy and ultimately discharged home.
CONCLUSIONS: Physicians should promptly address the recurrence of symptoms following an initial ST-elevation myocardial infarctions (STEMI) and be proactive regarding follow-up with the appropriate investigations.Although recurrence of STEMI within a few hours is extremely rare, the first 2 weeks following an initial STEMI is a critical time and patients should be educated on symptoms that will require further evaluation.The mortality associated with early recurrent myocardial infarction is up to 50% in 5 years so these patients require strict outpatient follow-up and counseling to minimize risk factors.

Hypoattenuated leaflet thickening (HALT), a potential aftereffect of transcatheter aortic valve replacement (TAVR) procedure, may affect valve performance and clinical outcomes. At this moment we describe an elderly patient who, despite being on prophylactic antiplatelet medication for previous percutaneous intervention (PCI) for coronary artery disease (CAD) and a self-expanding valve in-situ for aortic stenosis (TAVR), presented to the emergency room with non-ST-segment elevation myocardial infarction (NSTEMI), probably as a result of a thromboembolic event from HALT. The case highlights the significance of considering HALT-associated thromboembolism as a potential cause of myocardial infarction (MI) in post-TAVR patients.

A 70-year-old Japanese woman with hypertension, dyslipidemia, and diabetes mellitus complained of abdominal discomfort and vomiting and was brought to our emergency department by ambulance two days later with impaired consciousness. Her vital signs suggested shock with a heart rate of 120 bpm. Electrocardiogram and initial transthoracic echocardiography suggested an inferior wall ST-elevation myocardial infarction, but the altered consciousness was inconsistent. Contrast-enhanced computed tomography was urgently performed to further clarify the cause. It revealed pericardial effusion and apparent extravasation from the left ventricular wall, confirming the early definitive diagnosis of left ventricular free wall rupture. The patient underwent successful emergent surgical repair without sequelae. Differential diagnosis of left ventricular free wall rupture is important in patients with ST-elevation myocardial infarction and impaired consciousness. Contrast-enhanced computed tomography allows early diagnosis and treatment of this life-threatening complication.

UNASSIGNED: Coronary artery disease has a long preclinical phase before manifesting itself clinically due to diffuse non-obstructive disease, stenoses, or thrombosis.
UNASSIGNED: We present a case of a middle-aged male complaining of atypical chest pain, then severe retrosternal pain, and, eventually, effort angina. We performed non-invasive testing, coronary angiography, intravascular imaging, and flow reserve tests, each as appropriate. Cardiovascular risk control, optimization of drug therapy, and percutaneous coronary intervention were considered trying to comply with the best clinical practice.
UNASSIGNED: Diffuse non-obstructive coronary artery disease may present clinically in different ways. Exercise stress test might be sufficient to assess effort angina before a potential angiography. Flow reserve tests across the diseased vessel can distinguish between diffuse and focal pattern of the disease and assist in the adequate selection of therapy. Finally, intravascular imaging is invaluable for the assessment of the plaque risk features.

UNASSIGNED: ST-segment elevation myocardial infarction (STEMI) has traditionally been managed with immediate reperfusion of the culprit artery, primarily through percutaneous coronary intervention and stent placement. Emerging data are highlighting the crucial importance of post-infarct microcirculatory function assessment.
UNASSIGNED: This report presents a patient with an inferior STEMI who was successfully reperfused without stent implantation. Tools such as optical coherence tomography, fractional flow reserve, and positron emission tomography computed tomography N-13 ammonia were utilized, offering comprehensive insights into the anatomical and functional characteristics of both the epicardial vessel and microcirculation.
UNASSIGNED: The recovery of the reversible component of microcirculatory dysfunction, observable as early as 5 days post-infarction, might carry significant implications for clinical decision-making. Such insights can potentially influence contemporary treatment strategies, including the consideration of deferred stenting. This case underscores the significance of post-infarct microcirculatory function and its potential impact on therapeutic approaches.

Secondary thrombocythemia (ST), also called reactive thrombocytosis, is caused by a disorder that triggers increased production by normal platelet-forming cells and is characterized by the abnormally increased number of platelet and megakaryocytes in the bone marrow. Previous reports have found complications from malignant tumors, chronic inflammation, acute inflammation, acute hemorrhage, splenectomy, etc. to be the common causes of ST. However, reports of secondary thrombocytosis caused by antibiotics are limited and there are no reports of secondary thrombocytosis with acute myocardial infarction as the first presentation. If the patient is at high risk of thrombosis, intensive antithrombotic therapy is required. To raise clinicians\' awareness of drug-induced secondary thrombocytosis and to enhance antithrombotic therapy for high-risk patients, this article presented a case of drug-induced secondary thrombocytosis with acute ST-segment elevation myocardial infarction as the primary manifestation.
UNASSIGNED: An 80-year-old woman was admitted with cardiogenic shock due to post-activity chest pain. She was started on aspirin and clopidogrel antiplatelet therapy, then replaced aspirin with indolibuprofen, which has relatively few side effects. There was no significant decrease in platelet counts during treatment.
UNASSIGNED: Secondary thrombocythemia, characterized by nonspecific symptoms, is difficult to diagnose. Secondary thrombocytosis with acute myocardial infarction as the first symptom is uncommon, but is very urgent and associated with a poor prognosis. What\'s more, cause-specific treatment counts for secondary thrombocythemia. Therefore it is important to search for the causal factor of secondary thrombocytosis. Secondary thrombocytosis caused by cephalosporins is rare. There is a need to arouse the attention of clinicians to the ST caused by cephalosporins and to provide a guide of treatment to these patients.
UNASSIGNED: After a thorough analysis of the pertinent literature, we discovered that several retrospective studies demonstrated the effectiveness of cytoreductive therapy in significantly reducing platelet counts. Based on this finding, we prescribed hydroxyurea to our patient, which led to a gradual decrease in platelet count and ultimately resulted in a return to normal levels.

de Winter ECG sign is an anterior ST-segment elevation myocardial infarction equivalent, which refers to an occlusion of the proximal left anterior descending (LAD) coronary artery with tall T waves and the absence of ST elevations in the precordial leads on the electrocardiogram (ECG). This sign is often under-recognized and not treated as an ST-segment elevation myocardial infarction which can increase the morbidity and mortality of such a life-threatening condition. Here we report a characteristic de Winter ECG sign involving left circumflex artery as culprit vessel, which was managed with PCI.

UNASSIGNED: Myocardial abscess is a very rare life-threatening suppurative infection of the heart. Usually, myocardial abscess is a complication of infective endocarditis, and it is rarely associated with isolated myocardial infection. We present a case of an isolated myocardial abscess presenting with acute myocardial infarction.
UNASSIGNED: A 61-year-old man with a history of diabetes mellitus and coronary artery disease presented with a 3-h history of chest pain and inferior ST elevation. He had been treated for right-sided pneumonia 1.5 months prior to admission. Coronary angiography revealed acute occlusion of the posterolateral ventricular artery, and he underwent balloon angioplasty, which successfully restored TIMI-3 blood flow. Unfortunately, the patient went into cardiac arrest several hours later from which he could not be resuscitated. A post-mortem revealed a myocardial abscess in the inferior wall of the left ventricle.
UNASSIGNED: Myocardial abscess is a challenging diagnosis due to the speed of clinical deterioration and rarity. High clinical suspicion and urgent multimodality imaging may aid in the diagnosis.

BACKGROUND: Ischemia reperfusion injury (IRI) remains a major problem in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). We have developed a novel reperfusion strategy for PCI and named it \"volume-controlled reperfusion (VCR)\". The aim of the current study was to assess the safety and feasibility of VCR in patients with STEMI.
METHODS: Consecutive patients admitted to Beijing Chaoyang Hospital with STEMI were prospectively enrolled. The feasibility endpoint was procedural success. The safety endpoints included death from all causes, major vascular complications, and major adverse cardiac event (MACE), i.e., a composite of cardiac death, myocardial reinfarction, target vessel revascularization (TVR), and heart failure.
RESULTS: A total of 30 patients were finally included. Procedural success was achieved in 28 (93.3%) patients. No patients died during the study and no major vascular complications or MACE occurred during hospitalization. With the exception of one patient (3.3%) who underwent TVR three months after discharge, no patient encountered death (0.0%), major vascular complications (0.0%), or and other MACEs (0.0%) during the median follow-up of 16 months.
CONCLUSIONS: The findings of the pilot study suggest that VCR has favorable feasibility and safety in patients with STEMI. Further larger randomized trials are required to evaluate the effectiveness of VCR in STEMI patients.

Spontaneous coronary artery dissection (SCAD) has emerged as an increasingly diagnosed cause of ST-segment elevation myocardial infarction (STEMI), which is easily missed or delayed. The effective use of coronary angiography (CAG) and advanced intracoronary imaging examinations in STEMI patients has led to increased detection of SCAD.
A 59-year-old woman with acute angina pectoris was diagnosed with STEMI detected by electrocardiography combined with measurement of myocardial enzymes. Due to the ongoing pandemic of coronavirus disease 2019 (COVID-19) in Wuhan, she was first given thrombolytic therapy after excluding contraindications according to the requirements of the current consensus statement; however, subsequently, both the symptoms of ongoing chest pain and the electrocardiographic results indicated the failure of thrombolytic therapy, so the intervention team administered rescue percutaneous coronary intervention treatment under third-grade protection. CAG confirmed total occlusion in the distal left anterior descending (LAD) artery, with thrombolysis in myocardial infarction (TIMI) 0 flow, whereas the left circumflex and right coronary arteries appeared normal, with TIMI 3 flow. Intravenous ultrasound (IVUS) was further performed to investigate the causes of occlusion, which verified the absence of atherosclerosis but detected SCAD with intramural haematoma. During the operation, the guidewire reached the distal end of the LAD artery smoothly, the balloon was dilated slightly, and the reflow of TIMI blood could be seen by repeated CAG. During the follow-up period of one and a half years, the patient complained of occasional, slight chest tightness. The repeated CAG showed that the spontaneous dissection in the LAD artery had healed well, with TIMI 3 flow. The repeated IVUS confirmed that the SCAD and intramural haematoma had been mostly resorbed and repaired.
This was a case of failed STEMI thrombolysis in our hospital during the outbreak of COVID-19. This case indicates that doctors need to consider the cause of the disease when treating STEMI patients, especially patients without traditional cardiovascular risk factors. Moreover, CAG and intracoronary imaging examinations should be actively performed to identify the aetiology and improve the treatment success rate.