Case presentation After two and a half hours of discomfort in the midsternal chest, neck, and shoulders, a 63-year-old female was admitted to the emergency ward. The doctor gave her sublingual nitroglycerin (0.4 mg) and morphine (2 mg) immediately. She is a smoker and has a history of depression, hypertension, and gastroesophageal reflux disease.
An initial cardiovascular test showed a regular rhythm with no gallops or murmurs. Emergency examination Hypertension – 195/96 mm Hg Two subsequent echocardiograms - Sinus bradycardia at 59 beats/min, poor R-wave progression, and T-wave inversions in leads V1-V3 No QTc prolongation Troponin (tested at 6 hours interval) – 1.04 ng/mL, 1.54 ng/mL, and 1.11 ng/mL Cholesterol – 231 mg/dL LDL – 126 mg/dL HDL – 79 mg/dL Triglyceride – 150 mg/dL Transthoracic echocardiogram – Hypokinesis in the mid-left ventricular wall during systole Cardiac…
