Journal of Cardiology & Current Research Angina Equivalent and Revascularization in a Diabetic Patient with a Chronic Total Occlusion of a Single Coronary Artery Submit Manuscript | http://medcraveonline.com The initial test performed was an echocardiogram that showed a non dilated left ventricle with mild concentric hypertrophy, preserved LVEF (left ventricle ejection fraction) with normal wall motion, diastolic dysfunction (alteration of the ventricular relaxation). Valvular morphology and function were normal. We then decided to perform a SPECT stress test on a cyclo-ergometer, that showed development of significant hipoperfusion in all inferior wall segments with extension to posterior wall (Figure 2) with partial recovery with rest (Figure 3). During the test, the patient developed progressive dyspnea and vegetative symptoms that disappeared with rest. Following these results, a coronary catheterization was indicated. Left main coronary artery had no significant lesions, circumflex artery had a non severe lesion in the second marginal branch and the right coronary artery was chronically occluded in the proximal segment, with the presence of collateral circulation (Rentrop 3). SYNTAX Score was 12 points. After beginning medical treatment with atorvastatin, carvedilol and acetylsalicylic acid the patient presented only a slight improvement, so we decide to add clopidogrel and perform a percutaneous revascularization of the total chronic occlusion. Angioplasty was successfully performed (Figures 4-7), with the implantation of two everolimus DES (drug-eluting stents). The patient had a good clinical evolution with total disappearance of the symptomatology. Volume 6 Issue 5 - 2016 Cardiac Catheterization Laboratories, Área del Corazón, Hospital Universitario Central de Asturias, Spain *Corresponding author: Pablo Avanzas, Cardiac Catheterization Laboratories, Area del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain, Email: Received: July 23, 2016 | Published: October 04, 2016 Case Report J Cardiol Curr Res 2016, 6(5): 00222 Case Report A diabetic and hypertensive 75-year-old woman with a previous history of osteoporosis and arthrosis in both knees was referred to the Cardiology outpatient clinic due to the development of exertional dyspnea. The symptoms had progressively worsened in the previous two months. She did not have dyspnea at rest, orthopnea, paroxysmal nocturnal dyspnea, syncopes or chest pain. She was taking enalapril and metformin. Physical exploration was normal, with the exception of central obesity, with a body mass index of 31.2 Kg/m2. The blood analysis revealed a normal hemogram, with glycaemia of 145 mg/dL, total cholesterol 200 mg/dL, LDL 120 mg/dL, HDL 60 mg/dL, HbA1C 5,9% and a serum creatinine of 0.95 mg/dL. The electrocardiogram showed sinus rhythm with left bundle branch block (Figure 1). Figure 1: EKG in sinus rhythm with left bundle branch block. Figure 2: SPECT test findings at maximum exercise. Figure 3: SPECT test findings at rest.