Shradha Runwal1 , Sunil Gurumukhani2 , Pradyot Tiwari3 , Shreyas Runwal4 , Sanjay Shah5 , Tejas Patel6
A 51-year-old male patient was admitted to the hospital with sudden onset chest pain and diaphoresis. He had a history of smoking with a total load of 40 packyears, was non-diabetic and non-hypertensive. ECG showed ST elevation in leads II, III and aVF s/o acute inferior wall myocardial infarction. High levels of cardiac biomarkers (TnI and CK-MB) were recorded. He was thrombolysed with intravenous Streptokinase. Coronary angiogram showed 99% stenosis in mid RCA for which he was advised percutaneous angioplasty to RCA but the patient denied further intervention and took discharge against medical advice. 5 days later he again presented with an episode of acute onset chest pain. ECG was suggestive of reinfarction in inferior wall (as shown in figure 1) with high levels of CK-MB. Coronary angiography revealed 100% stenosis in mid RCA for which he underwent percutaneous angioplasty with drug eluting stent with a post procedure TIMI flow of grade 3 and the patient was transferred to the CCU for routine monitoring. However, 6 hours later patient developed diaphoresis and persistent hypotension. So further evaluation was done.
