Case StudiesQuiz of the month – June 2022
Take our patient case study quiz specially curated for you by our Faculty Member, Prof. Chern-En Chiang.
Nissen SE, Lincoff AM, Brennan D, et al.
Journal: N Engl J Med
First published: March 4, 2023 DOI: 10.1056/NEJMoa2215024
Case Study: A 67-year-old male comes to the ER with the complaint of excruciating anterior chest pain for 1-hour. The parameters measured in the ER are as follows:
Vital parameters | Blood pressure: 146/78 mm Hg Heart rate: 92/min Respiratory rate: 16/min |
ECG shows ST elevation over V1-V3, suggesting acute anterior MI, and pathological Q waves over leads II, III and aVF. Toponin I was 15.40 ng/mL. Urgent coronary angiograph shows total occlusion over LAD-M, patent left main, patent left circumflex, and 80% stenosis over RCA-M. Left ventriculogram showing moderate hypokinesis over anterior septal area and mild hypokinesis over inferior wall with an EF of 44%. Primary PCI with 2 DES over LAD-M and RCA-M was performed uneventfully.
Past history | Inferior myocardial infarction 4 years with medical treatment HT for more than 10 years with regular treatment Type 2 diabetes for 8 years Denied smoking Obesity with a BMI of 30.5 |
Lab data | Na 134 meq/L, K 4.2 meq/L Cr 1.05 mg/dL, eGFR 73 mL/min (CKD-EPI), UACR 350 mg/g ALT 32 mg/dL HbA1c 8.3% LDL-C 98 mg/dL, HDL-C 28 mg/dL, triglyceride 259 mg/dL Toponin I 15.40 ng/mL, hs-CRP 18.2 mg/dL Lp(a) 83 mg/dL [upper limit of normal Lp(a) = 30 mg/dL] |
Medication history
before admission | Amlodipine 5 mg OD, valsartan 160 mg OD, bisoprolol 5 mg OD Metformin 850 mg BD Aspirin 81 mg OD Atorvastatin 20 mg OD |
Investigation | Acute MI after successful PCI, and this is a second MI (previous inferior MI) Post-MI LV dysfunction (LVEF of 44%) Uncontrolled diabetes (HbA1c 8.3%) Suboptimal control of lipid levels (LDL-C 98 mg/dL) A very high level of Lp(a) (83 mg/dL) |