Coronary anomaly with a left ventricular accessory chamber: Is it left ventricular aneurysm or diverticulum?

A 60-year-old male hypertensive was suspected to have post myocardial infarction left ventricular aneurysm. His transthoracic echocardiogram performed elsewhere reported an inferior wall left ventricular aneurysm. He was referred for coronary angiography. His coronary angiogram and repeat transthoracic echocardiogram demonstrated an accessory chamber arising from mid-inferior wall synchronously contracting with the left ventricle suggesting a diverticulum. In addition, he had anomalous coronary arteries with coronary artery disease. His electrocardiogram did not reveal any features suggestive of a post infarct aneurysm. This case illustrates the importance of a comprehensive clinical and echocardiographic examination with a broad differential thought process.

Acute intracoronary thrombosis in a normal coronary artery following coronary angiography: thromboaspiration using a guide catheter.

A 60-year-old female presented with anterolateral non-ST elevation myocardial infarction and her coronary angiogram revealed severe left system coronary artery disease with a normal right coronary artery. Following coronary angiogram, she developed acute inferior wall and right ventricular ST elevation myocardial infarction with complete atrioventricular block and cardiogenic shock. Repeat coronary angiogram showed large proximal right coronary thrombus causing subtotal occlusion that was successfully aspirated using a guide catheter. The possible causes for intracoronary thrombosis following coronary angiography are discussed here.