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Indian Journal of Emergency Medicine

Volume  4, Issue 2, April-June 2018, Pages 147-152
 

Original Article

Anterior Wall Myocardial Infarction; Challenges in Recognition and Management in an IntellectuallyDisabled Patient in the Emergency Department

Tanmay Kumar Jha1, Ritu Sabharwal2, Chintala Venkata Sai Chiranjeevi3, Sarat Kumar Naidu4, Dheeraj Bhaskaran Nair5

1Resident 2,4Attending Consultant 3Senior Resident 5Head of Department, Department of Emergency Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh 201012, India.

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DOI: http://dx.doi.org/10.21088/ijem.2395.311X.4218.14

Abstract

Acute MI would rarely be a first differential diagnosis in a young boy of 19 years old withintellectual disabilitywith non-specific complaints. We present a case of a 19-year old boywithhistory of seizure disorder, who presented to the Emergency Department with complaint ofnon-specific chest discomfort since1 day.While being examined, he had one episode of seizure after which he suddenly developed cardiac arrest;he was immediately given high quality CPR along with DC shock (initial rhythm = VF) as per ACLS protocol. Post ROSC2D Echo revealed LV dysfunction with LVEF~ 40%. Post ROSC ECG revealed AWMI. Patient was loaded with antiplatelets, statins and anticoagulants. Patient underwent CAG which revealed single vessel disease. Subsequently, he underwent primary PTCA+ Stent (DES) to LAD with good end result. He was discharged in a stable condition after 6 days.

Keywords: ST Elevation Myocardial Infarction (STEMI); Anterior Wall Myocardial Infarction (AWMI); Acute Myocardial Infarction (AMI); Left Anterior Descending Artery (LAD); Coronary Angiography (CAG); Primary PTCA + Stent to LAD; Intellectual Disability; Ventricular Fibrillation (VF); Cardiopulmonary Resuscitation (CPR); DC Shock; Seizure Disorder; Generalized Tonic-Clonic Seizure (GTCS).


Corresponding Author : Tanmay Kumar Jha