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Reprint Address: Jamaji C. Nwanaji-Enwerem, phd, Harvard Medical School, Daniel C. Tosteson Medical Education Center, 260 Longwood Avenue, Suite 168, Boston, MA 02115
An 83-year-old man with a history of hypertension presents to the emergency department
with fatigue 2 weeks after an international hospitalization where he was medically
managed for a myocardial infarction (MI). His vitals and physical examination were
within normal limits; however, 12-lead electrocardiogram demonstrated evidence of
anterolateral MI (Figure 1). Laboratory results were notable for a N-terminal prohormone of brain natriuretic
peptide of 3020 pg/mL and high-sensitivity troponins 2 h apart of 558 ng/L and 541 ng/L.
A bedside point-of-care ultrasound was performed (Figure 2) and the patient was admitted to cardiology.
Figure 112-Lead electrocardiogram demonstrating evidence of myocardial infarction (ST segment
elevation and T wave inversion) in the anterior and lateral leads (V3–V6).
Figure 2Bedside point-of-care cardiac ultrasound in apical four chamber view showing aneurysm
(arrow) of the distal septum and inferior left ventricle (LV). Apical four view of
the heart during ventricular diastole (A) and ventricular systole (B).
ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction).
