To the Editor.—
Patients with impending myocardial infarction syndromes have been recognized, and following coronary arteriography, operations performed prior to the development of muscle necrosis.1 The following case report presents an extreme example of severe proximal coronary occlusive disease, the end stage of which was averted by bypass grafting.
Report of a Case.—
A 47-year-old man related a history of precordial discomfort and tightness of 18 months' duration. An evaluation in June of 1970 included normal electrocardiograms and a normal x-ray film series of the upper gastrointestinal tract. On July 17, during a two-step exercise test the patient noted slight distress after the 19th trip and walked over to a cot to lie down. A seizure and ventricular fibrillation then occurred. This was successfully terminated by closed chest massage, electrical shock, and airway support.For several hours the ECGs showed ST-segment depressions, but later that day returned to normal.