60 year old Female

History of Present Illness (HPI):

• Hx of hypertension, hyperlipidemia, diabetes and angina.
  • Angina unresponsive to beta blocker therapy.
  • Did not tolerate nitrates or other anti-anginals.
  • Non-insulin dependent diabetes; takes oral medication.
• Presented with shortness of breath and chest pain.
• Myocardial perfusion imaging (MPI) study demonstrated normal ejection fraction (EF) and reversible lateral wall ischemia.
• Chronic atrial fibrillation (AF); taking warfarin therapy.
• Cardiac catheterization revealed:
  • Normal left ventricular (LV) function - EF of 55%
  • Normal left main (LM) and right coronary arteries (RCA).
  • 85% occlusion, about 1 cm in length, in proximal circumflex artery.
  • 35% occlusion more diffuse in several views, eccentric in the left anterior descending artery (LAD); about a 20-mm lesion.
• Decision was made to medically optimize patient.