Dr Naveen K Mohan Staff grade Cardiology, D&GRI

Mr. K H 05/09/07 54 year old male Not feeling right in eve following football game in afternoon Gripping central chest pain 22:30 ~ 1 min – recurring every 30 mins More frequent – called 999 at 03:00 – pain constant Sweaty ++; nausea ++

Never smoked Not known diabetic or hypertensive TC 6.4 mmol/L, Chol:HDL 6.1 Trigs1.0TC 6.4 mmol/L, Chol:HDL 6.1 Trigs1.0 Father died of MI at 86 Father and sister – Hypertension + DM Prison officer – off on stress leave for 2 months

ECG - ambulance

IV morphine Tenecteplase IV heparin Admited to DGRI (5am) Pain free Pulse 74/min BP 118/73 SpO2 97% (air) Heart sounds 1& 2, no murmur Chest clear

Further pain 05:40 ST changes V2-4 D/W cardiology SpR WGI Glasgow – will d/w consultant Morphine

VF arrest 06:10 VF arrest 06:10 Precordial thump; DC shock 150j Precordial thump; DC shock 150j D/W Glasgow WGI D/W Glasgow WGI Tirofiban Tirofiban D/W on call consultant D/W on call consultant

Transferred to Glasgow 06:30 Further VF 07:00 – DC shock 150j WI Glasgow – cathlab – 08:10

Reviewed in clinic mid Oct Swimming; Hill walking Aspirin, Clopidogrel, Bisoprolol, Ramipril, Atorvastatin, Lansoprazole ECG; Echo

Discussion