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As in all ischemia interpretations with OMI findings, the findings can be due to type 1 AMI (example: acute coronary plaque rupture and thrombosis) or type 2 AMI (with or without fixed CAD, with severe regional supply/demand mismatch essentially equaling zero blood flow). CT angiogram showed extensive saddle pulmonary embolism.
CT angiogram chest: no aortic dissection or pulmonary embolism. Only after her troponin peaked at 500,000 ng/L did she get her angiogram, which showed a 100% left main occlusion due to ruptured plaque. Pericarditis? No further troponins were measured. Serial chest xrays: progressive bilateral pulmonary edema.
The "flu-like" illness suggests myo- or pericarditis, but that would be a diagnosis of exclusion. Then, part of the thrombus embolized into the LCx causing an inferoposterolateral OMI. (As Do not wait for the troponin; a lot of myocardium will be dead if you do. The case continues.
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