Circulation Cardiovascular Case Series

A 63-year-old white male was admitted with recurring chest pain of increasing intensity for ≈3 days. He had a known history of arterial hypertension and was obese, with a body mass index of 29.4 kg/m2. After seeking help at his family physician he was immediately transferred to our hospital using emergency medical services because of ST-segment elevations. On arrival he had severe chest pain with dyspnea and a lowered blood pressure of 90/60 mm Hg. On auscultation moist rales could be heard over both lungs, whereas heart sounds were normal. The abdomen was nondistended with normal bowel sounds and no palpable organomegaly. His extremities were warm and exhibited peripheral edemas on both sides. The ECG displayed sinus tachycardia at 102/min with posteroinferior ST-segment elevations and reciprocal ST-segment depressions in leads I, aVL, V2 and V3. Bedside echocardiographic assessment showed severely depressed biventricular function with a left ventricular ejection fraction of ≈15% and a dilated right ventricle measuring a tricuspid annular plane systolic excursion (TAPSE) of ≈1 cm. All heart valves were normal, and no signs of pericardial effusion could be observed.