Visual Diagnosis in Emergency Medicine| Volume 57, ISSUE 3, P395-396, September 2019

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Elderly Man with Post Myocardial Infarction Fatigue

      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 thumbnail gr1
      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 thumbnail gr2
      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).
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