#MedicalCase

Acute Anteroseptal MI (Family Physician)

Dr. Zahidul Hasan., MBBS, DFM, MSC EMERGENCY MEDICINE, FELLOSHIP IN EMERGENCY MEDICINE

 

Medical Case Details:

BACKGROUND -
A young patient with sudden severe chest pain, needs immediate evaluation. The patient was obese and a smoker, so there was a chance of developing CVD. Acute Myocardial infarction is a medical emergency, which needs immediate management to reduce mortality and morbidity.

SUMMARY -
A 42 years old male patient came in the ER with severe central chest pain with numbness of left hand since 1 hour. The pain was not relieved by taking rest. He was driving from a long distance and suddenly developed chest pain, and he stopped his car and took rest. But when it subsided, he came to our hospital. He was not diabetic or hypertensive, but he was a smoker for 10 years (5-6 sticks/day). He was obese. On Examination, he was conscious but looked anxious. BP was 130/90 mm /Hg, Pulse was 75/min, and Spo2 was 96% in room air. The chest was clear, and the abdomen was normal. No pedal edema was present. ECG was done bedside, which showed ST elevation in lead 3, AVL, V2-V5. He was put on O2 inhalation through nasal cannula 4 L/min. Tab Isosorbide dinitrate 5 mg S/L, Tab Aspirin 320 mg by crack, Tab clopidogrel 300mg PO stat, Tab. Atorvastatin 40 mg PO stat and Inj. Morphine 5 mg IV slowly. Then the was patient shifted to CCU after sending baseline lab works and Troponin.

 


    Discussions


    Dr. Faheem Anjum

    I have seen an inferior wall MI in a 22 year old medical student. He was smoker from last 4 years. Eventually he had to undergo Primary PCI.
    Take home message is, we shouldn't ignore chest pain in young adults as IHD is now common even at age less than 30.

    13.Mar, 12:00pm

    Dr. Zahidul Hasan

    You are right Dr. Faheem.

    13.Mar, 12:02pm

    Dr. Vikrant Khanna
    General Practitioner

    I agree with Dr. Faheem that he should undergo PCI also will like to see electrolytes report and any history of drug abuse like cocaine apart from smoking.Any past history of similar episode or is he on some treatment.Any past medical symptoms like depression,Anxiety neurosis but presently coronary angiography should be done.

    13.Mar, 12:52pm

    Dr. Amiya Kumar Chattopadhyay
    Cardiologist

    Patient is suffering from STEMI Anterior wall.
    Patient need thrombolysis followed by Angiography and based on the findings angioplasty with stenting.

    09.Apr, 10:31pm



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