Acute anterior wall myocardial infarction complicated by cardiogenic shook in an elderly female patient

    (Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing 100853, China)

    Case presentation

    A 73-year-old female was admitted into the Institute of Geriatric Cardiology, Chinese PLA General Hospital because of sudden chest pain accompanied with nausea and vomiting for 15 hours. At 3:00 on August 14th, 2011, the patient suddenly suffered from severe chest pain accompanied with perspiration, nausea, vomiting, and cold extremities, but she was under normal conscious level. In the emergency room, electrocardiogram(ECG) at 18:00 showed ST segment elevation on the precordial leads. Cardiac biochemical markers increased proportionally. The patient had a history of hypertension for 10 years which was poorly controlled, chronic bronchitis for several years, cerebral ischemia attack one month ago, and diarrhea one day before admission. She denied any history of smoking, alcohol drinking, or illicit drugs use.

    On admission examination, the blood pressure was 90/70mmHg and the respiratory rate 20 breaths per minute. Both lungs were clear with moist rales. Heart rate was 133 beats per minute. Percussion revealed a dull sound. A grade 2-3/6 diastolic murmur could be heard at the left second intercostal space(ICS). Dorsalis pedis artery pulse was weak. Transthoracic echocardiogram showed a left ventricular ejection fraction (LVEF) of 43%, a normal-size left ventricular cavity, moderate dysfunction involving the septal and anterior, lateral and apex segments of the midportion, the thinned left ventricle, and ventricular aneurysm at the apex. Chest radiogragh showed pulmonary infection. ......