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A 55-year-old, morbidly obese man body weight (BW) of 104 kg, body mass index (BMI) of 30.5 kg/m2 with known history of type 2 diabetes mellitus, hypertension, dyslipidemia and primary hypothyroidism, presented with acute chest pain and heart failure in 2007. Frank pulmonary edema and cardiomegaly were documented from admission chest film (Figure 1). The electrocardiogram (ECG) (Figure 2) showed sinus tachycardia, left atrial enlargement, tall R in V2 with ST depression in V2-4, Q wave and mild ST segment elevation in inferior leads. The cardiac enzymes were elevated, troponin T (TnT) of 1.84 ng/ml, CK-MB of 94.15 ng/ml. Echocardiography revealed severe hypokinesia of antero-apical-lateral, infero-posterior wall, causing low left ventricular ejection fraction (LVEF) of below 0.30. After administration of aspirin, clopidogrel, heparin and glycoprotein IIb IIIa antagonist, he was referred for emergent coronary angiography.

the bangkok medical journal

Improved angiographic findings in a high risk acute coronary syndrome patient after modest weight reduction, regular exercise and medication: A case report and literature review