Highlights Smart phone application use in follow up of post intervention acute coronary syndrome patients. This could individualize each patients follow up and shown higher satisfaction and comparable clinical outcomes. This should be explored further for long term benefits.

We report a case of a 49-year-old woman with a longer than usual main stem of the left coronary artery resulting in a meandering course of the left circumflex artery and a partially empty left atrioventricular groove. The case also highlights the potential implications of this incidentally detected coronary artery variant.

A man in his 50s was brought to the emergency department with a 4-hour history of severe, crushing chest pain radiating to his left arm. His medical history was notable for diabetes mellitus and hypertension for 10 years and nonalcoholic fatty liver disease. A prehospital electrocardiogram (ECG) was recorded by the paramedics (Figure , A), and he underwent fibrinolysis with tenecteplase before being brought to the hospital. On arrival at the emergency department, he was having persistent chest pain with a blood pressure of 130/80 mm Hg, and a heart rate of 96 beats/min. Oxygen saturation was 96% on ambient air. Systemic examination findings were normal.

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