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Abstract

Background: Acute coronary syndrome (ACS) is one of the leading causes of death worldwide warranting early recognition and intervention. Electrocardiographic (ECG) ST-segment changes commonly precede symptom onset. AngelMed Guardian device detects ST segment changes as a sign of ischemia in patients with prior ischemic heart disease and alerts the patient to seek timely medical attention.
Case: An 80 years old male with history of coronary artery disease, post-PCI and CSI atherectomy of mid LAD, hypertension, hyperlipidemia, paroxysmal atrial fibrillation underwent successful implantation of AngelMed Guardian device due to high risk of future ischemic events. Subsequently about a year later, his device alarmed despite the absence of chest discomfort or dyspnea, prompting hospital visit. Telemetry showed frequent atrial and ventricular premature contractions (VPCs) and ECG revealed sinus arrhythmia with first-degree AV block and occasional VPCs. Troponin levels were elevated with a rising trend suggestive of ACS. A coronary angiogram showed patent LAD stent with distal 40-50% stenosis, diminutive LCx at its bifurcation with AV groove artery and OM1 showed 95% hazy stenosis suggesting that this was the culprit lesion for her ACS. Subsequently PCI was performed with DES extending from LCx into OM1. The final result was excellent with no significant residual stenosis or plaque shift into bifurcating AV groove branch. Patient was then discharged in a stable fashion and enrolled in intensive cardiac rehabilitation and is doing fine.
Conclusion: This case highlights the role of AngelMed Guardian device in detection of silent myocardial infarctions through real-time cardiac ECG monitoring enabling timely diagnosis of ACS and intervention in otherwise asymptomatic high-risk patients and preventing subsequent major adverse cardiac events.