Document Type : Case Report
Department of Cardiology, Nepal Mediciti Hospital, Lalitpur, Nepal.
A 38-year-old man presented to the emergency department with ongoing chest pain. The patient had a sudden onset of central, crushing chest pain for 7 hours, with severity increasing in the last 2 hours. The symptoms were associated with sweating. He was a known case of hypertension and was on medication for the preceding 2 years. The patient was also prediabetic. His mother had hypertension and diabetes mellitus. There was no history of hypertension, diabetes mellitus, or cardiovascular disease in his siblings.
On general examination, the patient had an O2 saturation level of 95%, a pulse rate of 110 beats per minute, and a blood pressure of 110/90 mm Hg. On systemic examination, no abnormality was detected. Additionally, the complete blood count, renal function tests, blood sugar random test, and electrolytes were within normal limits. Electrocardiography demonstrated an ST elevation in the inferolateral leads. He also had a CPK-MB level of 82 IU/L and a troponin level of 11.6 IU/L. Echocardiography revealed a hypokinetic left ventricular inferior wall.
With a diagnosis of acute inferolateral wall myocardial infarction (MI), the patient was taken to the catheterization laboratory, where coronary angiography revealed normal coronary arteries. He was admitted to the CCU and was treated with aspirin, clopidogrel, low-molecular-weight heparin, atorvastatin, beta-blockers, anxiolytics, proton-pump inhibitors, and stool softeners. On the following day, cardiac magnetic resonance revealed curvilinear, confluent, and patchy subendocardial enhancement in the inferoposterior wall of the left ventricle. The features were compatible with MI. He was conservatively managed and was discharged on the fifth post-MI day.