Cas du mois Décembre 2022 - Cardiologie interventionnelle-

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An ST-suspension that swings like a pendulum

A 38-year old  man with a history of hypertension ,heavily smoker , diabetes type 2 , dyslipidemia and STEMI Inferior thrombolysed on 01/21 with success and  Angioplasty of the right coronary with DES Consulted  for typical paroxysmal chest pain occurring at night. The patient had a good compliance with therapy but no smoking cessation .the initial electrocardiogram was without abnormalities.Trans thoracic echography revealed a normal left ventricular function , the absence of valvular diseases, the absence of pericardial effusion and wall motion abnormalities,LA was normal . Lab tests notice essentially positive troponins .The diagnosis of N-STEMI has been retained and the patient was admitted to the ICU.Day 1 of hospitalization: Recurrence of angina with percritical electrocardiogram demonstrated wide QRS and anterior ST segment elevation .An emergency coronary angiography was performed through the right radial approach, showing a chronic occlusion of the first marginal artery, the anterior interventricular artery without significant stenosis and no intra-stent restenosis of the right coronary artery chronic.The post-coronary electrocardiogram showed the disappearance of anterior ST segment elevation (Figure 1).The patient was re-admitted to the ICU (electrical monitoring / 24h).On the following day the patient reported a recurrence of symptoms in the early morning + palpitations with spontaneous resolution .On returning to the central scope, a spontaneously resolved ventricular tachycardia and transient ST segment elevation was observed (Figure 2 and 3) .

What Would you do to this patient ?