65 M with sudden onset chest pain.

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A 65 old Retiered security guard and farmer presented with complaints of sudden onset chest pain since 6 hours associated with sweating.

Patient was apparently normal 35 years back, later he had an penetrating injury to left eye, while he was cutting wood small piece of wood penetrated in his left eye following which he used some herbal medication (applied on eyes), end up in blurred vision.

30 years back he had a History of fall (from vehicle) following which he had Right eye injury 

Patient currently using  HOMATROPINE BROMIDE Since 15-20 years. Attenders claims that he use eye drops to make his vision clear. If he didn’t use eye drops he then have blurring of vision.

Patient developed chest pain @ 4.30pm on 18\1\2021 which is sudden is onset ,progressive ,radiating to both shoulders with Epigastric discomfort. He went to physician in suryapet where he ordered an ECG which shows ST elevations in V2to V4, lead 1 and avL  and diagnosed with ANTEROLATERAL WALL MYOCARDIAL INFARCTION 

and gave Him inj. FONDAPARINOX 2.5MG IV STAT, TAB.CLOPIDOGREAL 75MG PO STAT, TAB.TELMISARTAN 40MG STAT,TAB.AMLODIPINE, and referred to us for thrombolysis.

Patient presented to ER ( Dr. Nikitha pgy2 ) around 11.00pm with mild chest discomfort ( after taking medications) 

Initial ECG recordings were obtained and troponin-I was positive.

INITIAL ECG SHOWS : PROXIMAL LAD GRADE 2 STEMI (V2,V3, V4, 5, V6 L1 AVL)

TIME OF ONSET OF CHEST PAIN TO PRESENTATION IS ROUGHLY 7 HOURS.

Planned for medical thrombolysis with streptokinase 

Indications : Ongoing chest pain and Evolving MI.

NO Absolute contraindications present like : 

No H/O Hemrrhagic / ischemic stroke

No H/o GI bleed

PRE-PROCEDURE ECGS

Pre-procedure vitals :

Bp-150/100mmhg

PR- 82bpm

RR - 20cpm

spO2 - 94% with room air

GRBS 100mg/dl 

Thrombolysis started with INJ. STREPTOKINASE 1.5M units IV over 90 min was given (due to technical issues) During thrombolysis patient had occasional left ventricular VPC’s, junctional rhythms& AIVR for a few seconds.

Serial ECGS :

Outside hospital 

Base line ECG @ presentation to ER: (11.00pm)

ECG1 :

15 min After thrombolysis: ECG 2 @ 12.10am

1 hour after initiation of thrombolysis: ECG 3 @12.55am

ECG IMMEDIATELY AFTER THROMBOLYSIS ECG 4 @ 1.25am

Serial ECGS were taken which showed significant STE reduction along with T wave inversion.

Patient didnot developed any complications.

Post procedure vitals :

BP - 120/80mmhg

PR - 67bpm

RR - 14cpm

spO2 - 96% on room air.

Overall procedure was uneventful.

1hr post thrombolysis ECG 5 @ 2.30am

Labs ; 

Hemogram

PT- 18sec 

INR- 1.33

APTT- 35sec

BT - 2.30 MIN

CT - 4.30 MIN

TROPONIN-1

Treatment Given :

TAB. MET-XL 50MG STAT

TAB. ATROVASTATIN 80MG STAT

INJ. STREPTOKINASE 1.5 MILION UNITS IN 50ML/hr

BP,PR,SPO2 , MONITORING.

THANK YOU UNIT-1 TEAM, DR.NIKITHA (DMO),        Dr. K. Vaishnavi (ICU).