A Crushing Emergency: Case of Acute ST-Elevation Myocardial Infarction

Case Scenario: A 60-year-old man is brought to the emergency department with severe central chest pain that started 3 hour ago while he was walking. The pain is crushing, radiates to his left arm, and is associated with sweating, nausea, and shortness of breath. The pain did not improve with rest or nitrates. He has a history of hypertension, diabetes and is a chronic smoker. No prior history of angina or MI. On Examination: BP: 100/70 mmHg Pulse: 105/min, regular SpO₂: 93% General: Anxious, pale, diaphoretic CVS: Normal S1, S2, no murmurs Chest: Fine basal crackles Investigations: ECG: ST elevation in V1–V4 Troponin I: Raised CK-MB: Elevated Chest X-ray: Mild pulmonary congestion Diagnosis: Anterior Wall STEMI Immediate Management: IV Morphine Oxygen Sublingual Nitrates Aspirin 325 mg (Chewable) Beta-blocker (Metoprolol) Antiplatelet (Clopidogrel 300–600 mg) Statin Definitive Treatment: Primary PCI within 90 minutes (preferred) If not available → Thrombolysis (Alteplase/Tenecteplase)

A Crushing Emergency: Case of Acute ST-Elevation Myocardial Infarction

More from Anila Sayyed

The Farmer Who Drank the Wrong Bottle — A Cholinergic Crisis Case

Immune-Mediated Mechanism of Rheumatic Fever and Its Sequelae (RHD)

Understanding Pneumonia Through Clinical Cases: From Diagnosis to Management

From Cure to Relapse: A Case of Recurrent Pulmonary Tuberculosis