• Sandeep Nathan.
• University of Chicago Medical Center, 5841 South Maryland Avenue MC 5076, Chicago, IL 60637-1470, USA. snathan@medicine.bsd.uchicago.edu
• Am J Health Syst Pharm. 2010 Aug 1; 67 (15 Suppl 7): S25-7.

PurposeThe case of a woman with progressive substernal chest pain is described.SummaryA 55-year-old woman arrived at the emergency department (ED) with a complaint of progressive substernal chest pain. Her medical history included hypertension and dyslipidemia. Upon arrival to the ED, the patient was free of chest pain. A chest x-ray was essentially unremarkable, and nonspecific inferolateral electrical changes were observed on the initial electrocardiogram (ECG). Initial laboratory test results were unremarkable, with the exception of the cardiac troponin level (0.23 microg/L). However, the patient complained of recurrent chest pain, and an immediate repeat ECG showed fairly significant new ST-segment depression. The patient was diagnosed with non-ST-elevation acute coronary syndrome (ACS). She received 600 mg of clopidogrel, along with i.v nitroglycerin, and subsequently underwent cardiac catheterization. Orthogonal views of the left coronary system clearly showed a high-grade lesion in the middle of the left anterior descending (LAD) artery. Percutaneous coronary intervention (PCI) was performed on the mid-LAD lesion using bivalirudin for procedural anticoagulation, and a 3.0 x 18 mm drug-eluting stent was implanted in the mid-LAD vessel. Brisk blood flow to the distal territory was observed at the conclusion of the case. The patient remained asymptomatic after PCI and was discharged on day 3 on several medications.ConclusionDiscussion of a patient with non-ST elevation ACS illustrates some of the clinical issues surrounding PCI and stent implantation, including selection and use of antiplatelet therapy.

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