A 71-year-old man, who had angioplasty and stenting of the main left and anterior descending coronary arteries 10 months earlier, is admitted to the CCU with non-ST-elevation myocardial infarction. He is scheduled to undergo coronary angiography:

• Marked sinus bradycardia, 45/min
• Poor R wave progression from V1 to V4 (previous anterior infarction)
• ST-T abnormality in I, aVL and the inferior leads , consider inferior-lateral ischemia

  One hour after admission the patient has sudden loss of consciousness. The ECG monitor revealed an arrhythmia:

•   Atrial fibrlllation with rapid ventricular response, followed by ventricular fibrillation

“Code blue” is called. Resuscitation procedures is promptly carried out and the patient is successfully defibrillated. He becomes fully conscious. The blood pressure is 110/72. The pulse is irregular, 130/min. ECG 3 is recorded:

• Atrial fibrillation with rapid ventricular response (134/min)
• Poor R wave progression from V1 to V3. Q wave in V4. 
• Previous anterior infarction
• Non-specific T wave abnormality

 The patient was taken to the cardiac catheterization lab. The stent in the main left coronary was fully patent. There were no new lesions in the left anterior descending and circumflex arteries. There was a proximal occlusion of the right coronary artery that was successfully dilated and stented. There were no complications and the patient had a satisfactory and stable clinical course.