Acute Myocardial Infarction

55 year old Malay male with no known medical illness with a history of 30 years of smoking 3 packs a day presented with his first episode of crushing central chest pain which occurred 1 and half hours before admission and was associated with shortness of breath, profuse sweating and nausea.

The pain occurred acutely while the patient was at rest and was described with a pain score of 10/10 and radiated to the patient’s back. There was no leg swelling, vomiting, syncope or fever.

On examination there were no significant findings at the emergency department other than slight tachypnea and a BP of 152/100 mmHg

At the emergency department the patient the ECG shower ST elevation in leads V1-V5 and CK, LDH and AST were raised to 5610, 1720 and 839 respectively. The patient was diagnosed with an acute anteroseptal infarction (Killip I). The patient was subsequently treated with IV streptokinase 1.5M units and serial ECG post streptokinase showed >50% reduction in ST segment elevation.

Day 2 of Admission

The patient had no active complaints and had no shortness of breath or chest pain.

However on physical examination the patient had crepitations bilaterally up to the midzone with no pedal edema and the diagnosis was then revised to a Killip II. The patient was subsequently treated with Lasix 40 mg BD.

Day 3 of Admission

The patient continues to be asymptomatic.

Physical examination was unremarkable and there were no crepitations in the lungs 

Serial cardiac enzyme monitoring showed a decreased in all enzymes

CK: 5610 à 1748

LDH: 1720 à 1463

AST: 839 à 259
The patient was noted to have a raised creatinine at 114 from a baseline of 67 at the emergency department

Echocardiogram done showed good LV function with EF of 50-55% with normal sized chambers with no clots.

LDL: was found to be 6.2 and the patient was started on T. Simvastatin 40mg OD

Fasting blood glucose was 5.7

Day 4 of Admission
The patient remained asymptomatic
Physical examination revealed no abnormalities
Renal function test showed a raised creatinine at 124
Patient was kept in the ward for monitoring of the renal profile


Day 5 of Admission
The patient remained asymptomatic
Physical examination revealed no abnormalities
Renal function test showed a raised creatinine at 140
Patient was kept in the ward for monitoring of the renal profile

Day 6 of admission
The patient was discharged with the diagnosis of Acute Myocardial Infarction with Acute Kidney injury due to ACE-i use.
The patient was discharged with an appointment to see a cardiologist in Hospital Johor Bharu and also for follow-up in the MOPD in 3 months
The patient was discharged with the following medications:
T. Cardiprin 100mg OD
T. Bisoprolol 1.25mg OD
T. Atorvastatin 40mg ON
T. Plavix 75mg OD
T. ISMN 60mg OD
S/L GTN 1/1 PRN
T. ranitidine 150mg BD