Anterior ST-Segment Elevation Myocardial Infarction in a 54-Year-Old Male Patient with Uncontrolled Hypertension: A Case Report.

Abstract

Background: ST-elevation myocardial infarction (STEMI) is the most severe and life threatening form of acute coronary syndrome. It is caused by complete occlusion of an epicardial coronary artery which leads to transmural myocardial necrosis. Rapid diagnosis of STEMI and reperfusion is essential to limit infarct size and reduce mortality. Uncontrolled hypertension is a major modifiable cardiovascular risk factor that causes accelerated atherosclerosis and predisposes to acute coronary events including STEMI.

Case Report: A 54-year-old male with uncontrolled hypertension was brought with a 15-minute history of acute chest pain radiating to the back and left arm. Blood pressure on arrival was found to be 147/100 mmHg and oxygen saturation was 94% on room air. A 12-lead ECG showed presence of ST-segment elevation in leads V2–V4 which subsequently progressed to extensive ST elevation across V1–V6, I, II, and aVR. Cardiac troponin T rose serially from below the detection threshold to 602 ng/L. Random blood glucose was found to be 438 mg/dL and serum potassium was 3.3 mmol/L. The patient received dual antiplatelet therapy, atorvastatin and sublingual nitrate. Subsequently he was referred to higher centre for primary percutaneous coronary intervention.

Conclusion:

Serial ECG monitoring and cardiac biomarker assessment are essential for diagnosing as well as tracking progression of STEMI. Concurrent diagnosis and management of associated risk factors such as hypertension, hyperglycemia and electrolyte  imbalance — alongside prompt reperfusion therapy are important from the point of view of optimal outcomes.