Myocardial Infarction, STEMI

No pain

Step 1: View clinicals

A 50 year old man presents with sudden-onset dyspnea for 2 hours. He denies experiencing chest discomfort or pain, but feels rather weak. His medical history is significant for poorly controlled diabetes for 10 years complicated by grade II retinopathy and peripheral neuropathy, and poorly controlled hypertension for 6 years. His smoking history amounts to 30 pack years. A screening ECG performed 6 months ago was normal.


Step 2: Order all relevant investigations

ECG

There are ST-segment elevations >2mm in leads V4-V6.

Tropoinin-T

The Troponin-T assay is positive.

Portable Chest X-Ray

The chest x-ray appears normal.

Portable Echocardiography

The echocardiogram shows isolated motion abnormalities of the lateral wall of the left ventricle. The ejection fraction is 53%. There is no evidence of valvular heart disease. The aorta appears normal.


Step 3: Select appropriate management

Aspirin
Oxygen
PCI
Enoxaparin


Score: ★★☆