History:
A 63-year-old with a history of CAD and CABG presented from cardiac rehabilitation (CR) with acute onset chest pain and shortness of breath. The patient underwent CR after an acute myocardial infarction one week ago. During that time, he had a similar presentation with chest pain and dyspnea and was diagnosed with anteroseptal STEMI. Emergent percutaneous coronary intervention (PCI) revealed severe stable CAD with patent left internal mammary artery to left anterior descending artery (LAD), Saphenous vein grafts (SVG) to obtuse marginal, SVG to the diagonal artery, and occluded SVG to right coronary artery (RCA). Considering the ongoing symptoms, a large septal branch was revascularized. The patient became symptom-free, and ECG normalized. Following his discharge at CR, he experienced similar symptoms and was sent to the emergency department for further evaluation.