67 yo M with a PMH of GERD presents with a 3 day history of dyspnea and sub-sternal chest pain radiating to both arms and jaws. The pain is associated with exertion and is very different from chest pains that he has had with his GERD. He was never short of breath with GERD. Even though he is 67, he never had GERD till two months ago, raising concerns that his GERD may actually have been a mild MI consistent with the Q waves seen in the septal leads. He has FH of dad dying from MI and younger brother already with stent s/p MI from CAD.
ECG – Showed T-Wave Inversion in inferior leads (II, III, aVF), Q waves in septal leads (v1-v2)
Cardiac biomarkers: Elevated troponin – 0.14 (H), 0.878 * (H), 0.754 * (H),0.647 * (H)
Echo was done on HD#1. That showed EF of 55 % to 60 %. There were no regional wall motion abnormalities. Impaired relaxation compatible with Grade I diastolic dysfunction. (reversed E/A ratio). Normal valves except for mild tricuspid regurgitation.
Angiography with stent placement done on HD#2: Proximal RCA has a 90% lesion on a curve with thrombus present. Successful PCI / Drug Eluting Stent of the proximal Right Coronary Artery with a 3.25 x 15mm Alpine stent. no residual stenosis.
Cardiologist recommendation after angiography with stent placement: Continue aspirin 325 mg daily for one month then 81 mg daily for the rest of your life. Continue plavix 75 mg daily for at least 12 months. Do not discontinue Plavix unless consulted by a cardiologist. Continue statin therapy.