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Double Culprits in a Patient with ST Elevation Myocardial Infarction: A Challenging But Rewarding Case

ACTA MEDICA INDONESIANA · Vol. 50 No. 2 (2018)

ISSN
2338-2732, 0125-9326
Terbit
2018-06-26
Penerbit
The Indonesian Society of Internal Medicine
Bahasa
eng

Abstrak

Myocardial infarction simultaneously involving two or more culprit lesions is extremely rare and usually has a poor clinical outcomes including mortality. Management of this complicated condition is challenging and limited time. Nevertheless, autopsy studies revealed that thrombotic occlusion of more than one major epicardium coronary artery is not uncommon. A 68-year-old woman presented with sudden onset of limited breath and chest discomfort since two hours prior to admission. She also felt exert dyspnoea since one month ago. She has two risk factors that were uncontrolled that is hypertension (HT) and type 2 diabetes mellitus (DM). On admission, she succumbed into cardiogenic shock and pulmonary oedema. ECG revealed a diminished R wave in V2-V4 with ST elevation in V2-V5 and in aVR. Biphasic T wave was seen in V2-V6. The working diagnosis was anterior STEMI, Killip class IV with thrombolysis in Myocardial Infarction (TIMI) score of 8. While being transferred to catheter lab, she gasped, became desaturation, and was intubated prior to procedure. The patient was given double inotropes which run maximally. By Coronary angiography, there were occlusions at the LAD and LCX. Stent was applied at proximal LAD and LCX. Subsequently, patient’s condition improved and post-procedure ECG showed improvement in aVR and precordial leads, and ST elevation was significantly diminished from V5 and aVR, and R wave came back in V2-V4.Previous study found around 50% of STEMI patients had multi-vessels diseases. In this case, ECG suggested LAD region infarction with ST elevation in aVR, commonly associated with left main stenosis (LMS) involvement.Thrombus aspiration in LAD and LCX yielded hemodynamic improvement. V-stenting technique, introduced in 1996, allows delivery and implantation of 2 stents together, and therefore shorten the stent deployment time.

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Rekan penulisOrganisasiArtikel bersama
Muhammad YaminInstitut Agama Islam Negeri Bone9
Andhika RachmanAfiliasi tidak diketahui6
Siti SetiatiAfiliasi tidak diketahui5
Idrus AlwiAfiliasi tidak diketahui5
Annisa Puspitasari NachrowiAfiliasi tidak diketahui5
Sally Aman NasutionAfiliasi tidak diketahui5
Arif MansjoerAfiliasi tidak diketahui4
Evy YunihastutiAfiliasi tidak diketahui4
Kuntjoro HarimurtiAfiliasi tidak diketahui3
Rudi PutrantoAfiliasi tidak diketahui3
Lugyanti SukrismanAfiliasi tidak diketahui3
Nurul Inayah RahmaniAfiliasi tidak diketahui3
Zahra Nuril AnwarAfiliasi tidak diketahui3
Ika Prasetya WijayaAfiliasi tidak diketahui2
Hamzah ShatriAfiliasi tidak diketahui2
Alvina WidhaniAfiliasi tidak diketahui2
Anshari Saifuddin HasibuanAfiliasi tidak diketahui2
Sukamto KoesnoeAfiliasi tidak diketahui2
Ni Made HustriniAfiliasi tidak diketahui2
Dono AntonoAfiliasi tidak diketahui2
Putri ZulmiyusriniAfiliasi tidak diketahui2
Angga Pramudita PudiantoAfiliasi tidak diketahui2
Alexander Edo TondasAfiliasi tidak diketahui2
Lusiani RusdiAfiliasi tidak diketahui2
Mu’arifuddin Mu’arifuddinAfiliasi tidak diketahui1
M. Ridho AlamsyahAfiliasi tidak diketahui1
Aprilia WidyastutiAfiliasi tidak diketahui1
Cikal Pangestika Nolanda PisalAfiliasi tidak diketahui1
Suzanna ImmanuelAfiliasi tidak diketahui1
Aida LydiaAfiliasi tidak diketahui1
Taufik IndrajayaAfiliasi tidak diketahui1
Tanya HerditaAfiliasi tidak diketahui1
Tracy Anabella HermansyahAfiliasi tidak diketahui1
Valerie Hirsy PutriAfiliasi tidak diketahui1
M Hafiz AiniAfiliasi tidak diketahui1
M Shiddiq Al HanifAfiliasi tidak diketahui1

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Sumber metadata: OAI-PMH (metadata jurnal) http://www.actamedindones.org/index.php/ijim/oai, pertama di-harvest 8 Nov 2026, terakhir terlihat 8 Nov 2026.
Metadata asli (oai_dc) 
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	<dc:title xml:lang="en-US">Double Culprits in a Patient with ST Elevation Myocardial Infarction: A Challenging But Rewarding Case</dc:title>
	<dc:creator>Ginanjar, Eka</dc:creator>
	<dc:creator>Yulianto, Yulianto</dc:creator>
	<dc:creator>Salim, Simon</dc:creator>
	<dc:creator>Setyawan, Wawan</dc:creator>
	<dc:subject xml:lang="en-US">ST elevation</dc:subject>
	<dc:subject xml:lang="en-US">myocardial infarction</dc:subject>
	<dc:subject xml:lang="en-US">STEMI</dc:subject>
	<dc:subject xml:lang="en-US">aVR</dc:subject>
	<dc:description xml:lang="en-US">Myocardial infarction simultaneously involving two or more culprit lesions is extremely rare and usually has a poor clinical outcomes including mortality. Management of this complicated condition is challenging and limited time. Nevertheless, autopsy studies revealed that thrombotic occlusion of more than one major epicardium coronary artery is not uncommon. A 68-year-old woman presented with sudden onset of limited breath and chest discomfort since two hours prior to admission. She also felt exert dyspnoea since one month ago. She has two risk factors that were uncontrolled that is hypertension (HT) and type 2 diabetes mellitus (DM). On admission, she succumbed into cardiogenic shock and pulmonary oedema. ECG revealed a diminished R wave in V2-V4 with ST elevation in V2-V5 and in aVR. Biphasic T wave was seen in V2-V6. The working diagnosis was anterior STEMI, Killip class IV with thrombolysis in Myocardial Infarction (TIMI) score of 8. While being transferred to catheter lab, she gasped, became desaturation, and was intubated prior to procedure. The patient was given double inotropes which run maximally. By Coronary angiography, there were occlusions at the LAD and LCX. Stent was applied at proximal LAD and LCX. Subsequently, patient’s condition improved and post-procedure ECG showed improvement in aVR and precordial leads, and ST elevation was significantly diminished from V5 and aVR, and R wave came back in V2-V4.Previous study found around 50% of STEMI patients had multi-vessels diseases. In this case, ECG suggested LAD region infarction with ST elevation in aVR, commonly associated with left main stenosis (LMS) involvement.Thrombus aspiration in LAD and LCX yielded hemodynamic improvement. V-stenting technique, introduced in 1996, allows delivery and implantation of 2 stents together, and therefore shorten the stent deployment time.</dc:description>
	<dc:publisher xml:lang="en-US">The Indonesian Society of Internal Medicine</dc:publisher>
	<dc:date>2018-06-26</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>http://www.actamedindones.org/index.php/ijim/article/view/825</dc:identifier>
	<dc:source xml:lang="en-US">Acta Medica Indonesiana; Vol. 50 No. 2 (2018): Acta Medica Indonesiana; 165</dc:source>
	<dc:source>2338-2732</dc:source>
	<dc:source>0125-9326</dc:source>
	<dc:language>eng</dc:language>
	<dc:relation>http://www.actamedindones.org/index.php/ijim/article/view/825/309</dc:relation>
	<dc:rights xml:lang="en-US">Copyright (c) 2018 Acta Medica Indonesiana</dc:rights>
</oai_dc:dc>