MI with new onset severe MR and AV block

 56 year old female patient  presented to emergency on 5/6/2021 with acute onset of chest pain 

Shortness of breath since 2 days.

Chest pain - severe, pain scale 10/10 , gradually progressive , diffuse ,over left precordial region and right sternal region .

Assosciated with shortness of breath - NYHA grade 4 --- , orthopnea ,PND+,

Patient had history of fall due to giddiness  4 days back ,no loc , vomitings,seizures .

No pedal edema ,no palpitations ,no sweatings .no wheeze ,no cough ,no decreased urine output .

No belchings ,no pain abdomen .

No history of similar complaints in the past .

Patient is known HTN since 5-6 months and on regular medication .

Ecg showing - QS complexes in 2,3,avf 

St depression in V1-v4 .


Inferio - posterior wall MI ,Trop I - 27858 .

Patient was started on Heparin infusion ,nicorandil infusion ,Clopitab ,metxl , atorvastatin .

Ecg on 7/1/21 - showed PR prolongation - 0.2 sec .

     First degree heart block 

Patient was hypotensive and started on ionotropes .

Planned for angiogram .but patient attenders didn't want to get it done .

Afternoon patient experienced giddiness and breathlessness 

Grbs was normal .

Peripheral pulse feeble 

BP-90/50 mmHg 

Ecg showed - mobitz type 1 block .


On examination patient is tachypneic ,PR - irregularly irregular - around 60/ min 

Bp-90/50 mmHg .

RS- bilateral Infraxillary crepts .

2d echo : 


8/1/21 - patient has  sob and on noradrenaline,dobutamine ,dopamine infusion .

Bp-100/70 mmHg .

PR-100/ min ,regular .

Ecg showing -  first degree heart block 








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