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

## TL;DR

This paper describes a case where remote monitoring detected unstable heart plaques before they caused severe issues, leading to timely treatment.

## Contribution

The case highlights the use of remote monitoring to identify plaque instability through arrhythmias and ST changes.

## Key findings

- Dynamic ST elevations and nonsustained ventricular tachycardia were detected via remote monitoring.
- Emergent revascularization of a nonculprit vessel was required due to plaque instability.
- The case demonstrates subacute plaque destabilization that can be clinically silent.

## Abstract

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.