Chronic Total Occlusion of the Left Main Coronary Artery in an HIV-Infected Patient

Figures & data

Table 1 Routine Investigations

Tests Performed	Result	Reference Range
Complete Blood Count
Hemoglobin (Hb)	9.7 g/dL	14.0–17.5 g/dL
White cell count (WCC)	6.3 x 10^9/L	4.5–11.0 x 10^9/L
Platelet count	153 x10^3/µL	156–373 x 10^3/µL
Comprehensive Metabolic Panel
Serum sodium	134 mmol/L	135–145 mmol/L
Serum potassium	3.7 mmol/L	3.5–5.1 mmol/L
Serum bicarbonate	24 mmol/L	22–26 mmol/L
Serum creatinine (Cr)	0.6 mg/dL	0.5–1.2 mg/dL
Blood urea nitrogen (BUN)	12 mg/dL	3–20 mg/dL
Alanine aminotransferase (ALT)	43 IU/L	20–60 IU/L
Aspartate aminotransferase (AST)	89 IU/L	5–40 IU/L
Total bilirubin	1.2 mg/dL	0.2–1.2 mg/dL
Alkaline phosphatase (ALP)	143 IU/L	40–129 IU/L
Albumin	3.2 g/dL	3.5–5.5 g/dL
Albumin-corrected calcium	10.2 mg/dL	9.6–11.2 mg/dL
Magnesium	1.8 mg/dL	1.6–2.3 mg/dL
Phosphorous	3.3 mg/dL	2.5–6.5 mg/dL
Fasting blood sugar	94 mg/dL	60–120 mg/dL
Infectious Disease Panel
Blood cultures	Negative	Positive or negative
Urine culture	Negative	Positive or negative
Cluster of differentiation 4 (CD4) count	623 cells/mm3	500–1500 cells/mm3
Human immunodeficiency virus ribonucleic acid (HIV RNA)	14 RNA copies/μL	< 20 RNA copies/μL
Cardiac Profile
Glycosylated hemoglobin	5.7%	4.3–6.5%
Fasting lipid panel
Cholesterol	142 mg/dL	170–200 mg/dL
Triglycerides	134 mg/dL	40–150 mg/dL
High-density lipoprotein	48 mg/dL	40–60 mg/dL
Low-density lipoprotein	68 mg/dL	60–130 mg/dL
Thyroid-stimulating hormone	2.87 mU/L	0.5–5.0 mU/L
Erythrocyte sedimentation rate (ESR)	34 mm/h	0–22 mm/h
High sensitivity C-reactive protein (hsCRP)	2.4 mg/dL	0.0–1.0 mg/dL
D-dimer	121 ng/mL	< 500 ng/mL
N-terminal-pro-brain natriuretic peptide (proBNP)	2257 pg/mL	≤ 300 pg/mL
Creatine kinase (CK)	167 U/L	30–170 U/L
Creatine kinase MB (CK-MB)	8 U/L	< 20 U/L
Lactate dehydrogenase (LDH)	533 U/L	313–618 U/L
High sensitivity troponin I (hsTnI)	0.88 ng/mL	0.0–0.15 ng/mL

Figure 1 The patient’s electrocardiogram indicates a wide complex tachycardia (WCT) and atrioventricular dissociation suggestive of ventricular tachycardia. The black arrows indicated the prolonged QRS duration, intrinsicoid deflection, and the red lines underscore the regular WCT.

Figure 2 The patient’s cardiac computed tomography angiography cross-sectional view illustrating the absence of the left main coronary artery (encircled in red) with the retrograde opacified left anterior descending (LAD), circumflex arteries (LCx) with their sub-branches, diagonal (D) and obtuse marginal (OM) (labeled).

Figure 3 The patient’s cardiac magnetic resonance angiography short-axis view displaying spontaneous echo contrast (encircled in red) suggestive of the depressed left ventricular function.