Abstract

A 62 year old male patient was presented in ER due to the sudden onset of a precordial chest pain for an hour which aggravated in the last 30 minutes along with vomiting. The patient had no medical co-morbidities as such but had a known case of haemorrhoids and was a chronic smoker. On admission, he was conscious about the time and place and his vitals were HR: 50, BP: 110/70 mm of hg, RR: 20/min, SPO2: 99% (RA), CBG: 163 mg/dl. We could not find any evidence of MI in ECG, or any wall motion abnormality in ECHO but the patient was still complaining of chest pain and diaphoresis even post getting treated with isosorbide dinitrate and ranolazine. So, we took the patient to the Cath lab for a coronary angiography, which revealed LCX proximal 95-99% disease and RCA minor plaque in mid-part and diffuse disease in distal RCA. Primary PCI to LCX was done and treated conservatively. From this particular case, we learnt the significance of coronary angiography in ACS even if there was no significant finding on ECG, ECHO or cardiac enzymes. Message: Coronary Angiography played a major role to rule out acute coronary syndrome even though there was no change in ECG, cardiac markers and 2D-Echocardiography.

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