MI - with acute idioventricular rhythm

 36 yr old male patient ,who is a tractor driver, was apparently alright 2 days back ,then  he developed chest pain - sudden onset , gradually progressive 

Pain at  reterosternal region , squeezing type type , radiated to left upper limb assosciated with profuse sweatings .

He had 1 episode of vomiting and then loss of consciousness for 1 min .

No sob , palpitations .

He is a smoker since 3 years - smokes 10-12 cigarettes /day 

He is occasional alcoholic .

He was taken to local hospital in nalgonda next day w,he was given loading doses as ecg revealed St elevations in anterior leads ,echo showed RWMA in apical region  and referred to higher centre .

Ecg showing hyperacute Tall T waves
With ST elevation in V2-V5

Patient went to another hospital,where Ecg showed AIVR ,TRop I and Trop T were positive.

Absent P waves,with broad QRS,St elevations in anterior leads- Idioventricular rhythm.


Patient presented to our casualty with severe reterosternal chest pain .

Sinus rhythm with 3mm St elevations in anterior leads ,poor R wave progression,Qs complex.


Vitals - PR-82/ min ,regular 

Bp-110/80 mmHg 

RR-20 /min 

Day 2- pain subsided ,angiogram was planned 
Sinus rhythm with st elevation 2-3 mm with Qs complexes in anterior leads .

Angio revealed recanalised LAD ,type 3 vessel ,mid 30% lesion with thrombus ,Distal and proximal LAD normal .


Filling defect in mid LAD 

Filling defect in mid LAD 


Day 3- 
Pain subsided .
Sinus rhythm with poor R wave progression from V1-v4 ,St coving with T wave inversions 


Treatment given in the hospital : 
1-Tab .Clopitab A 150 mg /OD
2- Inj .Heparin infusion 800u /hr for 2 days,later on cleaxne for 5 days.
3- Tab .MET XL 25 mg /OD
4-Tab.Aldactone 25 mg /OD
5- Tab .Cardace 1.25 mg /OD 

5-Tab.

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