35/M with chest pain

 35/ M patient who is a tractor driver and a farmer was apparently alright before 27/12/2020 

Patient while ploughing experienced severe chest pain - diffuse all around left precordium 

Radiating to left shoulder ,squeezing type ,lasted for more than 1-2 hrs .

Patient immediately went to a local RMP where his BP was 180/100 and was given antihypertensive ,and pain medication .

And he continued working .

He experienced similar pain in the evening and went to same local RMP and got some pain relief injection .

Patient says his pain relived .and he continued working 


On 1/1/2021 - while sparying pesticide, patient developed profuse sweating ,with left side chest pain , radiating to left shoulder and neck .

Patient ignored it and took some rest 

On 3/1/2021 patient had mild chest discomfort and approached a doctor . Where ecg and echo was done - suggestive of Anterior wall MI - he was given loading dose of aspirin ,clopidogrel ,atorvas ,and heparin stat .






Patient never had shortness of breath , palpitations ,orthopnea,PND ,giddiness ,nausea , vomiting .

No wheeze ,no chest tightness ,no epigastric discomfort ,no belching.

Patient is ex smoker - stopped since 10-12 years ( he smoked 1 beedi pack /day for 2-3 yrs) 

Chronic alcoholic - takes 90 ml of brandy daily after work .

He was referred for angiogram .


Patient presented here the same day : 

Ecg and --echo repeated showed  ( echo showed LAD territory akinetic ) 

4/1/21


5/1/21


8/1/21


He was started on heparin and nikornadil infusion.

Trop I -4.46 ,ck MB -6.5 ,cpk -225 .

Angiogram was done on 4/1/2021 - LAD complete occlusion 

Heparin infusion continued 

Recheck angio was planned after 3 days - on 7/1/2021 - CAG showed LAD complete occlusion 

He was given  TIROFIBAN infusion for 1 day and started heparin .


Diagnosis- CAD - AWMI ( thrombus in LAD causing complete occlusion) 

Deonvo HTN .








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