Acute AWMI -?Wrap LAD

 35 year old male patient who is a welder by occupation 

Was apparently alright  2 days back then he developed chest pain on 19/1/2021 at 11 am ,chest pain was reterosternal diffuse ,dragging type ,severe assosciated with profuse sweatings , palpitations ,shortness of breath -acute onset,severe and was unable to complete full sentence .

No syncope ,no pedal edema ,no wheeze ,no chest tightness.

He is chronic alcoholic since 5 years ,consumes daily after work .

Non smoker .

He visited a local doctor ,got some analgesics .He felt comfortable till 3 am the next day ,when he again developed severe chest pain associated with sob and was sleepless .He couldn't visit any hospital .

The next morning patient went to back to the same doctor ,and he was given loading dose and referred here .

Patient presented to our casualty with severe chest pain,pain scale 10/10 with sob .

Vitals -BP-100/70 mmHg ,PR-70/ min ,RR-21/min 

Sats-95% 

Ecg - showed ST Elevation in inferior and anterior leads .

Echo - RWMA + inferior wall and IVS 

Trop I -1.06 

Serial ecgs- showing progressive ST elevations in anterior and inferior leads .3rd ecg is one hour after Tenecteplase ( 7mm decrease in ST elevation)


He was immediately shifted to cath lab - Primary angiplasty was planned .

But Coronary angio showed - LMCA- Distal thrombus 

LAD- ostio proximal large thrombus + with distal embolization cut off .


Proximal LAD thrombus- filling defect.




As angio showed distal large thrombus he was planned for thrombolysis and check angio after 3 days .


He was given Tenecteplase 40 mg bolus ,and continued on heparin infusion .

6hrs after thrombolysis- ST elevations in anterior ,lateral , inferior leads with poor R wave progression .We can notice decrease in ST elevations in anterior leads V2-V6 .


Day 2- patient complaints of reterosternal  pain with sob .
Ecg showing 1 mm st elevation in lateral 1,avl leads ,with slurred s waves in inferior leads ,2-5 mm ST elevations in V2-V5.

Vitals stable and on treatment with 
  Inj Clexane 60 mg /BD
Tab .MET XL 12.5 mg /OD 
Tab .Cardace 1.25 mg /OD 
Tab.Pan 40 mg /OD .

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