Retrosternal chest pain

Chief Complaint A 42 yom presented at 9 in the morning with retrosternal chest pain for 6 hours. He described it as 8/10 intermittent pain which did not resolve on taking medication. History He has no past history of any heart disease. He has h/o surgery for appendicitis 7 years back. Vitals BP 179/100 mmHg, Respiratory rate 19 b/m, HR 69 beats/minute, Temp 98.1 degree C. Investigations ECG shows ST-segment elevation in II, III, and aVF, V6; and ST depression in aVL and V1-3. Another ECG showed more prominent ST elevation in II, III, aVF, and V5,6 and ST depression in aVL and V1-3. Coronary angiography - left anterior descending artery had a thrombosis in the distal segment. Rest everything looked fine. Treatment Opinion on the case?

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Dx'-acute inferolateral myocardial infarction. Immediate hospitalization in icu. If pt reaches within 3hrs to cardiac care unit angioplasty may be done. If more than 3hrs then conservative line of tt with throbolytic antiplatellate drugs and analgesic inj o2 support and antilipedemic drugs and antibiotics are given in icu.close monitoring is done fof pt status and hypertension for atleast 3weeks.

amlapitta proper aahar vihar to be followed, spicy food, pickles tea, coffe, oily and other junk food to be stopped mixutre of avipatikar chooran,madhu yashti chooran,each 2 gm b.d mukta pishtu 250 gm in two divided doses amla pitta mishran of dhoot papeswar. also advice him to do do sadhh vaman oce in 15 days

It is a case for primary angioplasty for acute myocardial infarction to restore myocardial perfusion and prevent further damage to myocardium

Angioplasty anti thrombotic anti hypertensive are primarily line of management

IWMI thrombolyse pt or if possible adv Primary PCI

Antihypertensives,antithrombolytic r helpful. In post angioplasty..