Harbingers of Plaque Instability: Dynamic ST-Elevation and Nonsustained Ventricular Tachycardia on Remote Monitoring

Coronary atherosclerosis is a chronic, multifocal pathophysiologic process punctuated by acute inflammatory flares causing plaque destabilization. Plaque destabilization may smolder over a subacute temporal course, which may be clinically silent with spontaneous lesion healing resulting in multilayered plaques. We report a case who initially presented with acute coronary syndrome with culprit vessel revascularization and residual nonculprit disease who developed arrhythmogenic threat and dynamic ST elevations on remote monitoring that required emergent revascularization of the nonculprit vessel.