Case of the day

Acute Coronary Syndrome

ACS - Ant wall STEMI, UTI, Grade 1 LV Dysfunction, Mild MR, LVEF 42%. Chief Complaints A 76 yr old female attended Emergency with chest pain, SOB,dysuria, pain abdomen since 5 days. No associated palpitation, diaphoresis, nausea, vomiting, fever, cough, loose stool, urine urgency or frequency or incontinence. No past H/O HTN, DM, Thyroid disorder, Substance abuse etc. Past H/O Stroke but no documents available, hence pt was not thrombolysed also her window period was of 5 days. Her General Examination and Systemic Examination were normal. Routine blood Ix and ECG was done showing ST Elevation in anterior leads with raised Trop I of 800. Conservative management was started. Urine reports were sent for RE and C/S showing numerous pus cells and growth of Enterococci. 2D ECHO was done showing Mild LV Dysfunction, Low EF of 42% and mild MR. Pt is being referred to higher center for Coronary Angiography and further Management.

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Urine infection needs antibiotic as per culture and sensitivity - in this case Amoxicillin with clavulanic acid Ischemic heart disease is cause of low election fraction,. Angiography and if required angioplasty may improve the ejection fraction

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Go for urine culture and sensitivity for dysuria. Rest management is very fine.

Treat UTI 1st Then plan for PCI. May be dobutamine tgerapy help in improving EF.

Uti with stemi Ef42 Do probnp Coronary angiography Cabg