After seeing your first booked patient in the consultation room, the nurse rushed in saying there is a patient who needs urgent care. A 58-year-old gentleman presents with crushing chest pain, shortness of breath & sweating that started one hour ago.
He describes it ‘as someone is standing on my chest’. The pain radiates to his neck & jaw. He denied any abdominal or back pain; his breathing has improved with oxygen & he has mild nausea. He has no history of similar pain & no history of heart problems.
Patient History
PMH: HTN, DM & Dyslipidemia on Fosinopril, Hydrochlorothiazide, Metformin, and Atorvastatin.
FH: Father died of heart attack at age of 53 years. His elder brother had CABG at age of 48.
Social History: Smoker 2 ppd for 20 years.
On Physical Examination:
BP: 95/65
Pulse: 110/min
Temp: 37.8°C
RR: 26/min
O2 sat: 97%.
ECG Findings
Immediately ECG done, the strip was as follows:
ECG Findings Interpretation
There is progressive ST elevation & Q wave in V2-5.
ST elevation is now also present in I and aVL.
There is some reciprocal ST depression in lead III.
This is an acute anterior STEMI.
The patient was transferred by ambulance to the hospital immediately.
Other Investigations
Other investigations were carried out, the findings were:
RBS: 14mmol/L
T.Cholesterol: 6.6mmol/L
LDL.C: 3.57
HDL.C: 1.09
Trig.: 1.94mmol/L
Facilitative Questions
What are the possible hypotheses for this case presentation in terms of most likely & less likely?
What are the points to be included in the history taking, in this patient?
What initial focused physical examination would you like to do?
What are the risk factors in your patient?
What is the essential management you need to do in this patient?
Which laboratory test do you need to do in this case?
What ECG changes may you expect in this patient?
Elaborate on the changes & significance of cardiac enzymes?
