Case An 82-year-old female patient with history of diabetes, arterial hypertension, gastroesophageal reflux disease, severe mitral stenosis and pulmonary hypertension due to recurrent thromboembolic events complained of a retroesternal pain. She reported it as a nocturnal burning sensation which had begun a month before. She sought medical assistance and underwent an upper gastroduodenal endoscopy (mild esophagitis, no significant alterations), an exercise treadmill test and a myocardial perfusion scintigraphy at rest / on pharmacologic stress. Two days later she developed acute pulmonary edema and had to undergo a cineangiocoronariography. Image 1: Myocardial perfusion scintigraphy (99mTc-MIBI) using tomographic technique showing results at rest (1st row) and on pharmacologic stress (2nd row) in the three orthogonal axes (short axis, vertical and long horizontal). Following, images of the polar map (quantifying the perfusion defects), the tomographic cuts regarding the maximum systole and the three-dimensional heart reconstruction (evaluating the left ventricle mobility) are presented.Image 2: Electrocardiographic record during exercise treadmill test (ETT), leads V1 and V2 Question:Based on the video and images provided, we can assume that her clinical history was most compatible with: a) Transient myocardial ischemia in the left ventricular anterolateral wall owing to an obstruction of the marginal branch of the circumflex artery (branch of the left coronary artery) b) Transient myocardial ischemia in the left ventricular anterior wall owing to an obstruction of the right coronary c) Transient myocardial ischemia in the left ventricular septal wall owing to an obstruction of the circumflex artery d) No abnormalities Time is Up! Time's up
