Abstract
In acute myocardial infarction, time equals muscle. Diagnosis and intervention within one to two hours of pain onset decreases mortality significantly.1 An event of acute coronary syndrome (ACS) is usually symptomatic and commonly seen in elderly population. Hence, ACS event in younger population, especially if asymptomatic, makes it a formidable diagnostic challenge. The following case is of a 32-year old woman who presented to the emergency room with severe abdominal pain; without any associated symptoms of chest pain, shortness of breath, palpitations, dizziness or sweating and was diagnosed with an inferior wall myocardial infarction (MI).
Highlights
A 32-yr old patient complaints of severe abdominal pain of 6/10 in intensity and burning located in the epigastric region without any radiation; associated with nausea and without any aggravating or alleviating factors
Cardiac risk factors like diabetes mellitus, hypertension, hypercholesterolemia, smoking, advanced age and family history of heart disease helps in provisional diagnosis
In a separate study conducted for analyzing the association of risk factors with the occurrence of MI, 21.3% of patients with four or five cardiac risk factors had acute myocardial infarction(AMI)
Summary
A 32-yr old patient complaints of severe abdominal pain of 6/10 in intensity and burning located in the epigastric region without any radiation; associated with nausea and without any aggravating or alleviating factors She has a history of peptic ulcer disease and is on daily regimen of proton pump inhibitors (pantaprazole). She has no other significant medical history like diabetes mellitus, hypertension, or coronary artery disease (CAD) She has no known drug allergies and denies history of alcohol abuse, illicit drug use and smoking. All vital signs are within normal limits She is diagnosed with peptic ulcer disease and was given intravenous pantaprozole 40 milligram; approximately half an hour later, she showed significant improvement in symptoms with decrease in pain. A conclusive diagnosis of Inferior wall MI was made from the EKG changes and new onset of regional wall motion abnormality on echocardiography
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