Non Invasive management of ACS -STEMI
Dr. Gvp Rao^*

*Corresponding Author: Dr. Gvp Rao, MBBS, DNB (Med)., DNB(Card)., FICC (Card)., PhD (Card)., MACC., MCSI Sr Consultant Cardiologist Specialist in Interventional, Heart Failure., & Rehabilitation, Hridhayam Heart Clinic - NMH Heart Care Center, Nashik, Maharasthra, India.

Received Date:  November 05, 2020
Publication Date: December 01, 2020

A Male patient of 81 years brought to the causality with a history of chest pain central chest for the last 12 hours associated with sweating, nausea, giddiness and syncope.

The modifiable factors are Tobacco and no other significant risk factors On examination his BP was 80/50 mm of Hg, Pulse rate was 35 per minute, spo2 89 on room air, CVS s1 s2 heard JVP elevated, short systolic murmur, Respiratory examination showed bilateral basal reputations.

Investigations initially ECG showed Hyperacute ST elevations inferior leads with extreme bradycardia and reciprocal ST depressions working Diagnosis ACS STEMI inferior wall with cardiogenic shock, Bradycardia kills class 3 /4 Plan of treatment and management.

This patient is unfit / contraindications for Primary plasty as well thrombolysis cannot be done for late presentation and in shock.

Planned to treat him conservatively.

Treated with IV heparin for x 48 hours, Inj NTG infusion 6 ml hour x 48 hours After reaching BP systolic more than 90 mm of HG, Inotrope support - Dopamine infusion 10 ml per hour tired as per BP and Heart Rate and Dobutamine infusion, Loading dose of Disprin 325mg, clopidogrel 300 mg, Atorvastatin 80 mg, oxygen 6 liters per minute x 6 hours, laxatives, Vit D3 60k sachet, ACE inhibitors - Ramipril 1.25 mg 1/2 tab gradually increased. Inj Lasix 20 mg IV BD, No beta blockers because of Brady cardiac and with a multivitamin, protein supplementation.

Post 48 hours his ECG showed 100 % ST resolution with QS and T inversions in sinus rhyme, HR 68 per minute and no chest pain and improved from cardiogenic shock and heart failure. His echo showed a good EF of 60% No RWMA and No effusion.

Finally discharged to home in a stable state with the advice of TMT after a month for further interventions required are not.

Note: If we have an ST resolution- TIMI 3 without chest pain, and no signs of heart failure and hemodynamically stable I feel EARLY OR PRIMARY INTERVENTION CAN BE WITHHOLD.

Please follow the below images for more information about this case.

Subsequent the figures 3-7 ECG all showing 100% ST Resolutions with QS and T Inversions in the inferior wall in sinus rhythm

Volume 1 Issue 4 December 2020
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