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Indian Journal of Emergency Medicine

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

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

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Indian Journal of Emergency Medicine 4(2):p 147-152, April-June 2018. | DOI: http://dx.doi.org/10.21088/ijem.2395.311X.4218.14

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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).

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

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