CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 3, May/June 2022 158 AFRICA The ECG on admission was similar to the first one, apart from more deep negative T waves in the inferior leads, with the addition to V6 (Fig. 2). TTE showed a 28% EF (Simpson biplane) with anterior and lateral wall abnormalities, reduced cardiac index (1.8 ml/min/m2), moderate ischaemic mitral regurgitation and minor tricuspid regurgitation. The coronary angiogram showed a double total occlusion of the left circumflex coronary artery (LCX) and the left anterior descending coronary artery (LAD) with thrombolysis in myocardial infarction (TIMI) flow 0 in both arteries (Fig. 3). We decided after a discussion with the heart team to perform a double percutaneous coronary intervention (PCI) of both occluded coronary arteries, the LCX first. After predilatation with a small balloon, the LCX was opened and a drug-eluting stent was implanted, with good results (Fig. 4). The LADocclusionwas approachedwith a standard guidewire Fig. 1. ECG 1 showing sinus rhythm with negative T waves in the inferior leads, septal Q waves, ST-segment elevation in V1 and V2 and a Q3T3S1 pattern. Fig. 2. ECG 2 with similar findings to ECG 1, apart from more deep negative T waves in the inferior leads, with the addition to V6.
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