Chest pain radiating to left side

Chief Complaint A 54 year old female came to ED with the complaint of chest pain of 3 hours which is radiating to the left arm, neck and upper back. She said she had mild chest pain yesterday also which resolved on its own in 30 minutes. History He has a history of hypertension. She is a chronic smoker for the past 20 years and drinks occasionally. Investigations Her ECG shows T wave inversion & ST-segment elevation in Leads I, aVL, and V1-V6 and ST-segment depression in other leads II, III, and aVF. Which suggests acute STEMI. A coronary angiogram was done which shows left coronary aneurysm and stent thrombosis. Treatment What do you advise?

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Thrombolysis with clot specific and short acting thrombolytic therapy like TNK tPA tenecteplase. Further CABG in long term survival benefits.

Thrombolysis . Let settle the or then may need CABG as there is left coronary aneurysm

Thrombolysis. Thrombolytic therapy. Regular monitoring and evaluation required.

Thanks Dr Sandeep Ghodekar
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