Abstract
A 62 year old male patient was presented in ER due to the sudden onset of a precordial chest pain for an hour
which aggravated in the last 30 minutes along with vomiting. The patient had no medical co-morbidities as such but
had a known case of haemorrhoids and was a chronic smoker. On admission, he was conscious about the time and
place and his vitals were HR: 50, BP: 110/70 mm of hg, RR: 20/min, SPO2: 99% (RA), CBG: 163 mg/dl. We could
not find any evidence of MI in ECG, or any wall motion abnormality in ECHO but the patient was still complaining
of chest pain and diaphoresis even post getting treated with isosorbide dinitrate and ranolazine. So, we took the
patient to the Cath lab for a coronary angiography, which revealed LCX proximal 95-99% disease and RCA minor
plaque in mid-part and diffuse disease in distal RCA. Primary PCI to LCX was done and treated conservatively.
From this particular case, we learnt the significance of coronary angiography in ACS even if there was no significant
finding on ECG, ECHO or cardiac enzymes.