Case Scenario
A 55-year-old man presented with severe, substernal chest pain. The pain started 3 hours ago with the sensation of pressure in his chest, and it has been increasing in severity.
He had a few similar episodes in the past couple of days, but the pain resolved on its own. The patient’s temperature is 37.0°C , blood pressure is 80/40 mmHg, pulse is 60/minute, and respirations are 25/minute.
The patient appears in distress and diaphoretic. Physical examination is otherwise unremarkable. An intravenous line is obtained, and normal saline is administered. Which of the following is the most appropriate next step in the management of this patient?
A) Obtain an echocardiogram
B) Obtain an emergent chest x-ray
C) Obtain a 12-lead ECG
D) Immediate admission of the patient for catheterization
E) Immediate administration of fibrinolytic agent
Case scenario
A 71-year-old diabetic woman presented with severe central chest pain for 30 minutes this morning. She says the pain was cramping in nature and radiated down her left arm.
Her temperature is 36.8°C (98°F), pulse is 97/min, respirations are 18/min, and blood pressure is 163/91 mm Hg. Cardiovascular examination shows no abnormalities. ECG is obtained and is shown below. Which of the following biochemical measures would most likely be elevated and remain elevated for a week after this acute event?
A) Creatinine kinase-MB B) Alanine aminotransferase C) Lactate dehydrogenase (LDH) D) Aspartate transaminase E) Troponin I
ST ELEVATION MI
ST elevation in
- lead 1 ,aVL, V2, V3 , v4,v5, v6
- ANTERO-LATERAL MI
- LAD
CASE HISTORY –
A 50 year old smoker with hypertension develops central crushing chest pain radiating to his jaw. He has vomited and now feels short of breath. ECG was done which is shown.
v2-v5 & I - extensive anterolateral
Questions: What is the diagnosis? a. Posterior MI b. Inferior MI c. Antrolateral MI d. Pericarditis
Patient is given Morphine, anti-emetic and aspirin. He is taken immediately to the cardiac cath lab, where he undergoes coronary angiography and stenting to one of the vessels. Which coronary artery is stented? a. Right b. Circumflex c. Diagonal d. Left anterior descending (LAD)?
Case Scenario
A 75-year-old man presented with a 2hour history of crushing central chest pain. He is known to be an ex-smoker, hypertensive and diabetic on medications. Physical examination was unremarkable. His ECG is shown
What is his most- likely diagnosis? inferior mi - STEMI What are his management options? depends on acute or after 12 h - PCI on acute then fibrinolytic if not indicated
For all patients with STEMI
- Adjunctive medical therapy
- Continuous telemetry, serial ECG
- Serum troponins every 4–6 hours
- ICU level of care
