1. ST ELEVATION INFERIOR WALL
MYOCARDIAL INFARCTION

2. DOA 26/2/2013
• 47/M SERVING OFFICER
• CHEST PAIN X 1-2HOURS
- RETROSTERNAL CONSTRICTING
• DIAPHORESIS

3. RISK FACTORS
• No life style related
• Family history of CAD present

4. EXAMINATION FINDINGS
• HYPOTENSION
• BRADYCARDIA
• JVP RAISED

5. Raised JVP

6. ECG first degree heart block with
Evolving ST changes

7. Defibrillator showing ST changes and
bradycardia

8. Streptokinse started at ICU- Door to
needle time less than ½ hour

9. Cardiac monitor during thrombolysis

10. Trop T positive after 12 hrs

11. X-ray -chest PA view no
cardiomegaly/ pulmonary edema

12. Post thrombolysis ECG showing
resolution of ST elevation

14. After thrombolysis BP normal

15. LAB Investigations
• Hb 14.4g/dl
• TLC 9000/cumm
• Plt 307 10X 3
• Sugar R 107 mg/dl
• Urea 32 mg/dl
• Creatinine 1.2mg/dl
• S Na 143 meq/l
• S K 4.0 meq/L
• Total cholesterol 144 mg/dl
• Trg 84 mg/dl HDl 40 mg/L
• Cp K ( MB) 11U/L
• LDH 294 U/L

16. D2 patient comfortable transferred to
AH ( R&R) for PCI

17. 2 D ECHOCARDIOGRAPHY
• Normal ejection fraction- 60 %
• No RWMA

18. CAG ( Coronary angiography) at AH
R&R

19. CAG-05/03/13
• Non critical LAD
• LMCA normal
• LCX- non dominant
• RCA dominant

20. FINAL DIAGNOSIS
• Coronary artery disease -ST elevation
Inferior wall myocardial infarction- post
thrombolysis normal Left ventricular
function-Non critical LAD.