60 Year Old Man With Sudden Onset Heavy Chest Pain

A 60 year old male presents to the emergency room with sudden onset of substernal hest pain that has lasted for 30 minutes and radiates to the left arm. the pain is accompanied by dyspnea, diaphoresis and nausea. He has a history of hypertension, hyperlipedemia and smoking.

What is the differential diagnosis on the basis of above given history?

• Myocardial infarction
• Angina
• Pericarditis
• Aortic dissection
• Pulmonary embolism
• Gastroesophageal reflux disease
• Pneumothorax.

What workup will you advice to help in diagnosis?

• ECG
• Cardiac enzymes; CPK-MB, troponin
• Cest X ray
• Complete blood count
• Serum electrolytes
• Echocardiography

ECG done is shown below:

Note the ST elevation in the inferior leads (II, III and aVF). The ECG also shows ST depression in leads V1, V2 and V3 - likely a result of reciprocal changes associated with the MI.

 What is the Final Diagnosis?

Acute Inferior Myocardial Infarction