[Acute coronary syndrome without ST segment elevation in a 78 year-old woman caused by critical proximal right coronary artery stenosis with concomitant chronic total occlusion of left main coronary artery]. / Ostry zespól wiencowy bez uniesienia odcinka ST u 78-letniej pacjentki z krytycznym zwezeniem proksymalnego odcinka prawej tetnicy wiencowej i ze wspólistniejaca przewlekla okluzja pnia lewej tetnicy wiencowej.

Total occlusion of the left main coronary artery is a rare finding at coronary angiography. When present, patients most often have extensive collateral circulation from the right coronary artery. The mainstay of treatment is surgical with coronary artery bypass grafting. We present a case of a 78 year-old woman admitted to our department with two days history of nonspecific, abdominal pain. Her coronarography revealed chronic total occlusion of left main with concomitant critical, proximal right coronary artery stenosis.

[Simultaneous subacute thrombosis in bare metal stents implanted into right coronary artery and left anterior descending artery without coexistence of resistance to antiplatelet therapy]. / Równoczesna podostra zakrzepica w stentach metalowych implantowanych do prawej tetnicy wiencowej i galezi miedzykomorowej przedniej bez wspólistniejacej opornosci na leki antyagregacyjne.

In-stent thrombosis is a rare but devastating complication of coronary stent implantation, occurring in 0.5% to 1.9% of patients with bare metal stents (BMS). The most frequent clinical manifestation of stent thrombosis is ST elevation myocardial infarction (STEMI) and 30 day mortality is 50%. In-stent thrombosis can present as acute (within 24 h), subacute (within 30 days), late or very late after stent placement. We describe a case of a patient presented with STEMI due to subacute stent thrombosis, which occurred simultaneously in BMS, 3 days after implantation. The patient was successfully treated with balloon coronary angioplasty and discharged from a hospital in good condition.

[Tako-tsubo syndrome - a form of acute coronary syndrome or completely different clinical entity - a case report]. / Zespól tako-tsubo - forma ostrego zespolu wiencowego czy calkiem odmienna jednostka chorobowa? Opis przypadku.

Tako-tsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is a temporary left ventricular dysfunction characterised by acute retrosternal rest pain, ST - segment elevation, slight elevation of cardiac necrosis markers, preferential apical akinesia or hypokinesia with basal hypercontractility in echocardiography. Its clinical picture mimics an acute coronary syndrome. Coronary angiography reveals normal coronary arteries. The characteristic symptoms occur after emotional or physical strain. We report a case of woman admitted to the hospital who presented with symptoms of acute coronary syndrome with ST - segment elevation. Patient clinical presentation and tests results led to a diagnosis of tako-tsubo cardiomyopathy.