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Smith comment 2: I frequently see failure to control BP in patients with acute chest pain or acute heartfailure. The angiogram showed scattered mild luminal irregularities of the LAD, the LCx, and the RCA and a 95% distal RCA occlusion in a right dominant system. This was a presumed culprit and a stent was placed.
He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heartfailure, myocardial infarction, or any prior PCI/stent. Learning points 1] Acute Coronary Syndrome has many shades of clinical manifestation. Breath sounds were clear in all lung fields.
When OMI is captured in this early phase, there exists the highest amount of salvageable myocardium and least likelihood of heartfailure at hospital discharge. Cardiology felt her chest pain to be, most likely, the result of coronary supply-demand mismatch in the context of HCM endothelial remodeling (i.e.
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Coronary Angiogram 
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