Treating a 55-Year-Old With Severe, Substernal Chest Pain, Nausea, Vomiting and Left Arm Radiation
A 55-year-old male presented after having two hours of continuous, severe, substernal chest pain with associated nausea, vomiting and left arm radiation. The initial ECG showed anterior ST-elevation V1-V6 (Figure 1). He underwent emergent PCI. Thrombectomy was used, with subsequent stenting with TIMI grade 1-2 flow. With additional treatment, TIMI flow had increased to TIMI grade 2-3 by the end of the procedure, and he was admitted to the CICU.
Twenty-four hours later: Peak TnI > 50 ng/ml, peak CK-MB 400 ng/ml
An ECG the next morning showed reduced but persistent ST elevation in V1-V3, with Q waves in V1-V6 (Figure 2).
Echocardiogram showed severe septal, anterior and apical hypokinesis to akinesis.
Four days later, he developed mild to moderate, burning indigestional upper epigastric pain, different from his presenting symptoms. The repeat ECG showed no significant change from the second day ECG (Figure 2), with persistent Q waves. The repeat echocardiogram was unchanged from prior, with no pericardial effusion.
Repeat markers were sent; the demonstrated an TnI of 8.4 ng/ml and CK-MB of 3.2 ng/ml.
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