59 year old Male

History of Present Illness (HPI):

• Morbidly obese patient: BMI = 61
• Hx of COPD, possible obstructive sleep apnea, systemic hypertension, hyperlipidemia.
• Presents with severe substernal chest pain.
• ECG revealed sinus rhythm with ST elevations in leads 2, 3 and aVF, with QS complexes in same. ST depression noted in leads 1 and aVL.
• Acute coronary syndrome diagnosed.
• Emergency cardiac catheterization revealed:
  • Right Coronary Artery: 100% occlusion; dominant vessel.
  • Left Main: Normal.
  • Left Anterior Descending: 30% occlusion proximal portion.
  • Left Circumflex Artery: Normal.
  • Ramus Intermedus: 60% occlusion at origin.
  • Left Ventricle: 45-50% ejection fraction (EF).