36 year male presented to casualty at around 8.00pm yesterday with complaints of chest pain and epigastric pain radiating to back since 4.00 pm, associated with profuse sweating.
No h/o SOB/palpitations/syncope
No h/o vomitings/loose stools
No h/o fever/cold/cough
No other complaints
K/c/o CAD 3 yrs back - s/p PTCA
K/c/o HTN since 3 yrs and on treatment (unknown)
Not a k/c/o DM/ Asthma/ Epilepsy/ TB
Chronic alcoholic & smoker since 15 yrs
O/E: pt c/c/c
Temp: afebrile
PR: 68bpm , irregularly irregular
BP: 160/120mmhg
RR: 32cpm
Spo2: 99% on RA
CVS: S1S2 heard , No murmurs
RS: BAE + , NVBS
P/A: soft , NT
CNS: NFND


INVESTIGATIONS




 









TROP-I : Negative
S.Amylase : 71
S.Lipase : 18

DIAGNOSIS: Proximal LAD STEMI

TREATMENT: 
Inj.Enoxaparin 60mg IV/ stat
Inj.Pan 40mg IV/ stat
Inj.Zofer 4mg IV/ stat
Inj.Tramadol 1 amp in 100 ml NS IV/ over 20 min
Tab.Aspirin 325mg stat
Tab.Clopidogrel 300mg stat
Tab.Atorva 80mg stat
Tab.Met-xl 25mg stat

No symptomatic relief with these medications
Pain scale 10/10

Inj.Fentanyl 50mcg IV/ over 5 min given
Pain relieved

Then patient is referred to higher centre in v/o need for further evaluation and management by a cardiologist

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