HPI: Mr.

Nielsen, a 65 year old man, complains about chest pain

with tightness, radiating to both upper limbs. The pain started
about an hour ago. He also presents with shortness of breath,
nausea without vomiting, and sweating.

PMH: He has a history of cardiac angina, hypertension and

diabetes .He is being treated with amiloride, hydrochlorothiazide,
and metformin.

SH : Smokes one pack per day

PHYSICAL EXAM:

VITAL SIGNS:

BLOOD PRESSURE : 171/100 mmHg

PULSE : 84

BREATH RATE : 20 /min

OXYGEN SAT : 91%

BLOOD GLUCOSE : 158 mg/dl

TEMPERATURE : 37 degree C

URINARY OUTPUT : 0.64 mL/kg/h

AIRWAY : Clear and not obstructed

BREATHING : AUSCULTATION : Vesicular breath sound
bilaterally; normal to percussion and palpation

CIRCULATION: CAPILLARY REFILL TIME : 1.5 seconds ;

PULSE : Strong and rhythmic ; HEART AUSCULTATION : S4
gallop , no rub, no murmur

DDX:

- ST elevation myocardial infarction

- Non-ST elevation myocardial infarction

- Pulmonary embolism

LAB TEST AND IMAGING :

12-LEAD-ECG : ST segment elevation in lead I,II,V4,V5,V6

CBC : Erythrocytes : 3.7 ( decreased) ; hemoglobin: 34(

decreased) ; hematocrit : 34% ( decreased)

ABG : WNL

CARDIAC BIOMARKERS : Troponin : 0.15 ng/ml (increased) ;

Myoglobin : 225 ng/ml ( increased)

LIPID PROFILE: Total cholesterol : 304 mg/dl (increased) ; LDL:

243 mg/dl (increased)

CHEST X-RAY : Mediastinum enlargement, cardiomegaly.

CORONARY ANGIOGRAPHY : Total occlusion of the middle left
anterior descending artery. No significant stenosis in other
coronary arteries.

TREATMENT AND INTERVENTION :

- High flow O2 mask

- MEDICATION - Lisinopril and Bivalirudin given

- Cath lab- Angioplasty was called.

DIAGNOSIS:

ST ELEVATION WITH MYOCARDIAL INFARCTION.