Left Main Coronary Artery Disease

A 50-year-old male smoker with hypertension was brought to the emergency room by EMS. He reported several months of exertional chest pain. Over the previous week, the pain had increased in frequency; on the day of admission, it occurred while the patient was at rest. The last episode was accompanied by diaphoresis and shortness of breath. The patient was given nitrates in the ambulance and was pain free by the time of arrival at the emergency room. Physical examination was unremarkable. Electrocardiogram (ECG) showed nonspecific changes (Figure 1).