Quick Case: Young patient with anterior wall myocardial infarction

Summary

A 40-year-old male patient presented with retrosternal pain and perspiration that was occurring for the past hour. He had mild chest pain a couple days prior. An ECG was done, and results were normal. A fresh ECG shows mild ST elevation in V1-V2. The patient was immediately referred. Hospital ECG showed anterior wall myocardial infarction. At the time the PAMI was done, he had a 95% blockage of the left anterior descending artery.

Background

When the results are normal in the first ECG done for a patient with chest pain, that does not exclude the possible presence of cardiac disease. Patients must be kept under observation, and repeated serial ECG can clinch the diagnosis, at times.

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Case Presentation

This case involved a 40-year-old male patient with no history of chronic illness, who presented with central chest pain with much perspiration. The patient was quite uncomfortable in the clinic. ECG showed mild ST elevation in comparison to the one taken 2 days earlier.

Investigations

ECG: Anterior wall myocardial infarction
Angiography: LAD 95% blocked

Differential Diagnosis

Dyspepsia

Treatment

Hospitalization and PAMI

Outcome and Follow-Up

Good outcome, with the patient experiencing a stable recovery.

Learning Points/Take Home Messages

Do not ignore chest pain. A single normal ECG needs confirmation with a serial ECG taken after a couple of hours. In a suspected patient, rely more on clinical judgment rather than a negative ECG. Cardiac enzymes are also a useful tool and can help differentiate between cardiac and non-cardiac pains.

About The Author

Dr. Vachharajani is an experienced practicing family physician in Ahmedabad, Gujarat, with a special interest in obesity and lifestyle-related disorders. With a genuine passion and enthusiasm for healthcare information technology (HIT), he has championed the cause of using HIT in day-to-day clinical practice. In addition to his, MBBS, he holds a post-graduate certificate in environmental and occupational health (PGDMCH).

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2 Comments

  1. Dr.Pramod Kumar Sharma
    Posted Nov 2013 at 3:27 pm | Permalink

    Your presentation reminds me of a pt.who was 40 yrs,with hypercholesterolemia and a strong F/H of CAD(both of his parents died of heart attack at early age),came to me with typical anginal pain,his ECG was normal,tab.Disprin was given with a tab. of Sorbitrate.He became alright after few minutes.Echo and TMT done after few days were normal.He came to me for same pain few more times and every time ECG was normal hence Stress Echo was done which was normal.In the mean time he consulted a Sr.Intervertionist cardiologist at one of the best Cardiac centres of Delhi and was told to continue with low dose Aspirine and Atorvastatin and don’t worry.
    One early morning he came to me with similar chest pain and his ECG showed acuteness in ST-T angle which was not pesent in earlier ECGs,I sent him to same Cardiologist but he told him that nothing is there go home.At 4 pm he came to me with similar pain again,I repeated the ECG which showed Hyper-acute A/S MI.I ref.him to same centre again,CAG done which showed significant obstruction in LAD,Stenting was done.He is alright since 7-8 years.

  2. jayesh vishariya
    Posted Nov 2013 at 5:24 pm | Permalink

    i had a pt m/37 who is to complain retro sternal chest pain very atypical not related to ex
    always relived vth h2 receptor bloker
    reports were wnl
    pt suddenly died in sleep 2yrs later at 39
    pm report showed mi
    was that pt suffered from angina
    if so how he is to get relief vth h2 bloker

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