#0001

Acute inferior STEMI in a smoker

Patient

54y ยท Male

Date

1 Sept 2026

STEMIPrimary PCIEmergency

Chief Complaint

Crushing chest pain going to my left arm for 2 hours

Clinical Case

age

54 years

sex

M

occupation

Taxi driver

habits

smoking

30 pack-years, current

Crushing chest pain going to my left arm

Duration

2 hours

History of Present Illness

onset

Sudden, at rest

character

Crushing, retrosternal

radiation

Left arm and jaw

severity

Severe

pain score

9

associated symptoms

  • Sweating
  • Nausea
  • Shortness of breath

Current Medications

  • Metformin 500 mg twice daily

medical

Type 2 diabetes for 6 years, hypertension

allergies

None known

hereditary diseases

Father died of MI at 60

vitals

BP

100/65

HR

52

RR

22

TEMP

36.8

SPO2

94%

general

Distressed, diaphoretic, cold peripheries

systemic

cvs

S1 S2 heard, no murmurs, JVP not raised

resp

Fine basal crackles bilaterally

labs

  • High-sensitivity troponin I 4,800 ng/LOn arrival
  • Potassium 4.1 mmol/L

imaging

  • Echo: inferior wall hypokinesia, EF 45%Day 1

other

  • ECG: ST elevation in II, III, aVF with reciprocal changes in I, aVLOn arrival

primary diagnosis

Acute inferior ST-elevation myocardial infarction

differentials

  • Aortic dissection
  • Acute pericarditis

medications

  • Aspirin300 mg loading, then 75 mg dailyOn arrival
  • Ticagrelor180 mg loading, then 90 mg twice dailyOn arrival
  • Atorvastatin80 mg nightly

procedures

  • Primary PCI with drug-eluting stent to the right coronary arteryDay 0

lifestyle

  • Smoking cessation
  • Cardiac rehabilitation

follow up

Cardiology clinic in 2 weeks