Paroxysmal atrial flutter of extremely short duration.

Ficui 4a (upper). Early frame from a right sided injection showing normal right coronary artery (RCA) and a large diagonal branch. FIGURE 4b (lower). Later frame, same injection. The anterior descending artery (arrow) is seen filling retrograde. episodes of prolonged chest pain which were not associated with any evidence of myocardial necrosis. Physical examination was normal. Coronary arteriography was performed. The left anterior descending artery could not be filled from the left main coronary artery ( Fig 3), nor from an anomabus origin in any of the sinuses of Valsalva. However, there was late retrograde filling of this vessel from the right coronary, via septal arteries and collaterals ( Fig 4). This confirms complete obstruction of the left anterior descending artery at its origin from the left main coronary artery. The clinical and arteriographic evidence dovetail neatly to provide confirmation of the significance of the isolated U wave inversion after exercise. It is noteworthy that the abnormal U wave changes with effort are in proximity to the anatomic area of ischemia and demand.