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Soon afterward, the patient’s symptoms return along with lightheadedness, bradycardia, and hypotension. The patient has also developed sinus bradycardia, which may result from right coronary artery ischemia to the SA node. Two stents were placed with resultant TIMI 3 flow. Just another NSTEMI.
He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent. Learning points 1] Acute Coronary Syndrome has many shades of clinical manifestation. No appreciable skin pallor. Here is the time-zero 12 Lead ECG.
His first electrocardiogram ( ECG) is given below: --Sinus bradycardia. Here is the coronaryangiogram: A distal thrombotic right coronary artery (RCA) occlusion ! The lesion was successfully stented. Here is the post-intervention angiogram and post-PCI ECG. No reciprocal ST-segment depression (STD). --QT
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Bradycardia 
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