45M Myocardial Infarction 2Weeks Thyroid Issues 10 Years MP PaJR

 

February 03, 2024

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.

Patient came with chief complaints of chest pain 1 episode 6 days back

Patient was apparently alright 10 to 12 years when he developed increased drowsiness for which he consulted a doctor and was diagnosed to have hypothyroidism for which he used medication for 2 to 3 years and stopped it.he developed generalised body pains more on the neck and back insidious in onset, intermittent aggravated on working and relevied on taking rest. 

Then 1 week back after his dinner (non veg) he started feeling tightness in his chest (like acidity in patient's words) and started feeling hot and his breath became heavy for which he tried to on the fan and became unconscious as he got up. The pain was localised non radiating. When he got unconscious his family members observed that he was profusely sweating and pass urine involuntarily following which his family members took him to the hospital for which treatment was done for coronary artery disease, acute inferior wall mi with EF 45%

He later got consciousness at approximately at 12 am to 1 am

No H/O nausea, vomiting, fever, cold, cough

No H/O weight loss

DAILY ROUTINE: -

Patient has no fixed daily routine 

He has been working as a cab driver for the past 25 to 30 years

Patient said that he has been working excessively with lack of sleep in the past 1 month

PAST HISTORY

Known case of hypertension since 2 years on regular medication

Known case of hypothyroidism 10 to 12 years back for which he used medication for 2 to 3 years and stopped

Known case of TB when the patient was 7 or 8 years old and took medication 

Not a known case of diabetes, epilepsy

PERSONAL HISTORY: -

Appetite: normal

Bowel and bladder movements: regular

Diet: mixed

Sleep: normal

Addictions: non-alcoholic, smoker for 15 to 16 years 22 bidis every day stopped after the episode if chest pain

GENERAL EXAMINATION: -

Patient conscious coherent and cooperative 

Pallor absent

Icterus absent

Clubbing absent

Cyanosis absent

Lymphadenopathy absent

Pedal edema present pitting type 

EXOPHTHALMOS OBSERVED: -

SKIN CHANGES NOTED: -

TRUNK AND ARMS

LATERAL VIEW NECK FOR THYROID SWELLING

VITALS: -

BP 90/70 supine 80/60 standing

PR 84

GRBS 114

Temp afebrile 98.7

CVS EXAMINATION

Inspection: -

Chest wall is normal 

No scars, veins or sinuses

Apical impulse not seen

Palpation: -

No kyphoscoliosis

Apical impulse normal felt in 5th inter-coastal space later to the mid axillary line

No pulsations or thrills felt

Auscultation: -

S1, S2 heard no murmurs heard

RESPIRATORY SYSTEM: -

Bilateral air entry present

Non vesicular breath sounds heard

ABDOMEN: -

Soft, non-tender

No organomegaly felt

NERVOUS SYSTEM: -

No focal neurological deficits

INVESTIGATIONS: -

ECG ON 28/01/24

ECG ON 29/01/24

ECG ON 30/01/24

ECG ON 03/02/24

ECG ON 04/02/24

CHEST X RAY 04/02/24

CORONARY ANGIOGRAPHY DONE ON 30/01/24

TREATMENT GIVEN: -

Tab.Ecospirin 150mg OD 

Tab.Isosorbide mononitrate 10mg BD

Tab.Atorvastatin 40mg HS

Tab.Clopidogrel 75mg OD

Tab.Pantoprazole 40mg OD

[14-03-2025 07:24] PPM 1: Thyroid ke liye kaun si goli kha rahe hain thoda share karenge?

Translation - What is the medication being taken for Thyroid? Please share.

@CR we may need to mirror and update this patient's case report linked in the description box.

[14-03-2025 09:58] PA: good morning sir🙏Happy Holi

[14-03-2025 10:00] PA: sir abhi koi bhi goli nhi kha rahe agar khani h toh aap bataye

Translation - Sir at present not taking any medicine, if necessary, please advise.

[14-03-2025 10:10] PA: Kitne dinon se thyroid wali goli bandh hai?

Translation - Since how many days has the patient stopped taking thyroid medicine.

[15-03-2025 10:19] PA: 🙏good morning sir

[15-03-2025 10:20] PA: 10 saal se nhi li sir (Not taken since 10 yrs)

[15-03-2025 16.52] PPM 1: 👍

[20-03-2025 11.05] PA; Good morning sir. 🙏

[20-03-2025 11:07] PA: Sir thyroid ke liye medicine leni h,agar leni h toh konsi lenih plz bataye

[20-03-2025 17:04] Rakesh Biswas Sir: Nahi leni

Thyroid report normal aaya hai

[20-03-2025 17:05] PPM 1: Thyroid goli unhone 10 saal pehle kitne dinon ke liye liya tha?

[20-03-2025 18:59] PA: sir 3 year li thi

[20-03-2025 19:00] PA: goli leni ki jarurat nhi h kya sir

[20-03-2025 21:41] PPM 1: Woh wala prescription hai?

[20-03-2025 21:42] PPM 1: Nahi is bar ka test dekh kar nahi lag raha ki thyroid ki ab koi bhi

 samasya inhen hai

[20-03-2025 21:58] PA: thik h sir

[20-03-2025 21:58] PA: 🙏

[21-03-2025 11.22] PA:  Good morning sir🙏

[24-03-2025 10.57] PA: Breakfast 3 rotis with egg curry

[24-03-2025 16.08] PA: Lunch with 3 rotis egg curry and veg salad

[27-03-2025 10.36] PA: Breakfast watermelon.

[03-04-2025 09.43] PA: Breakfast

[03-04-2025 15.11] PA: sir ek baar Bp aur ECG check kr lijiye koi problem toh nhi h

[03-04-2025 19:45] PPM 1: Unhen kuch problem mehsoos ho raha hai?

Woh aajkal dawai kya kya le rahe unka photo share kijiye please.

BP instrument khareed kar ghar mein ghantey ghantey par din mein 10 bar dekhna zaroori hoga.

@~~PPM3@~PPM5 @~PPM4 would you like to compare his current ECG shared today above with that of the ones shown in his case report in the description box and share your inputs?

[03-04-2025 20:33] PPM 5: Sir, his old ECG has II, III, and aVF ST elevations, suggesting an inferior wall MI.

Also I am not entirely sure about it, but I think the amplitude in the later ECGs (3/2/2024 and 4/2/2024) are high, which could indicate left ventricular hypertrophy.

I think we were added after the ECG was shared sir, so I am not able to see today’s ECG.

[03-04-2025 22:50] PPM 3: Same sir

[03-04-2025 22:50] PPM 3: Can't see the ecg

[03-04-2025 23:04] PA: hm sir pain hota haii chest m

[03-04-2025 23:04] PA: bp bhii high tha aj checkup m btaya doctor ne

[03-04-2025 23:05] PA: ji sir m krti hu share CLOPITAB

[04-04-2025 07:27] PPM 1: 👆Yeh kabka hai?

[04-04-2025 07:28] PPM 1: We had a discussion on this clopidogrel vs Aspirin trial following DAPT and published it yesterday.

[04-04-2025 07:30] PPM 1: Ekbar check karne par pata nahi chalta

BP instrument khareed kar ghar mein ghantey ghantey par din mein 10 bar dekhna zaroori hoga.

[04-04-2025 07:31] PPM 1: Agar aap Indore mein hain to humare team member @~~PPM3 se wahan mill sakte hain

[04-04-2025 08:28] PA: ji sir 2 rotii khane k baad walk pr jate haii fir bhii pett tight ho rha hai gas ho rhii haii motion paas nhi ho rha breathing problem ho rhii pett tight hone ki wajah se khana nhi khil rha haii

[04-04-2025 08:32] PPM 1: Yeh sab heart ke wajah se bhi ho sakta hai.

Walk par jane ke baad jab aisa mehsoos ho to patient ko thodi der aaram se kahin safe jagah par khada hokar ya baithkar rest lena zaroori hai

[04-04-2025 09:44] PA: sir pet kadak ho jayega ish dar ki bajah se khana nhi kha rahe  pls kuch bataye 

[04-04-2025 16:04] PPM 1: 👆yeh kal raat ke baad se nahi khaye?

Kuch dahi chawal aur salad jaise le sakte hain

[04-04-2025 16:21] PPM 5: Sir, II, III and aVF have deep Q waves, signifying an old MI.

The T wave is inverted in aVR, aVL, V5 and V6, which could mean lateral wall ischemia.

V1 to V4 leads have ST segment elevation (more prominent in V2 and V3) which could perhaps mean an anterior wall MI.

[04-04-2025 16:23] PA: ji sir nhi khaya

[04-04-2025 16:50] PPM 1: Good! What are the text book causes of persistent ST elevation long after an ST elevation MI? We had shared something similar in the collective group recently

[04-04-2025 16:51] PPM 1: Bhook nahi hai? Bhook lage to halka kha sakte hain

[04-04-2025 17:40] PA: ji sir, sir apke hisaab se koi  dar  bali  baat toh nhi h

[04-04-2025 18:14] PA: 🙏sir kal ke baad ab yh roti le rahe h 12 pm se loosemotion bhi ho rahe h

[04-04-2025 20:26] PPM 5: persistent ST elevation after an ST elevation MI can be due to:

• ongoing ischemia

• ⁠acute thrombotic coronary occlusion 

• ⁠left ventricular dysfunction 

• ⁠pericarditis 

• ⁠LV aneurysm 

This paper also suggests that malignant infiltration of the heart could lead to asymptomatic ST segment elevation, sir

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.036584

[05-04-2025 08:28] PPM 1: Pehle constipation tha? Motion zyada hone ke liye koi dawai liye hain? 

Ab pet ka tight hona thoda kam hua hai?

[05-04-2025 08:29] PPM 1: Going by this patient's entire history and context which of these causes are more likely to be true for this patient?

[05-04-2025 08:33] PA: 🙏good morning sir, sir abhi unko aram h ges ki bajah se paresani ho rahi thi ab kuch thik lg raha h

[09-04-2025 11.20] PA: 3 phulkas with salad and curry.

PPM 1: 👍

[11-04-2025 16.35] PA: sir 2pm pr lunch  liya tha duty pr network nhi tha ishliye  send  nhi ho pa raha. Lunch3 phulkas, aloo curry and salad

[11-04-2025 22.23] PA: Dinner 2 phulkas, cabbage and veg salad

[12-04-2025 09.11] PA: 🙏good morning sir. Breakfast 2 phulkas cabbage and curry.

[13-04-2025 10.52] PA: Breakfast 2 roti, dal and raw onion pieces.

[13-04-2025 14.01] PA: Lunch 3 roti and sabji

[27-04-2025 10.20] PA: Breakfast 2 roti and dal

[27-04-2025 11.06] PPM 1: 👍

[27-04-2025 14.32] PA: Watermelon

PPM 1: 👍

[29-04-2025 11.26] PA: 3 roti and sabji

[30-04-2025 21.16] PA: Rice with dal. Orange juice.

PPM 1: 👍

[17-05-2025 12.38] PA: Good afternoon sir. 

[17-05-2025 21.29] PA: Dinner

[04-06-2025 11.30] PA: good morning sir🙏

[04-06-2025 15.49] PA: 

[05-06-2025 13.15] PA: good afternoon sir🙏

[14-06-2025 10.00] PA: Good morning sir

[14-06-2025 10:10] PPM 1: 👍

[14-06-2025 10:10]PPM 1: Yeh bahut dangerous khana hai!

[14-06-2025 13:32]PA: Good afternoon sir

[14-06-2025 13:33] PA: sir bh ujjian me h isliye le liya age se dhyan rakhenge