A 46 years Male from Islamabad came to ER with complains of Epigastric and retrosternal pain for 16 hours. The pain was constricting type , continuous, radiating to left arm and neck, and not relieved in any position. It was associated with Shortness of breath. He had 3 episodes of Vomiting and sweating. He also complains of palpitation. Headache +, LOC followed the event and he was rushed to ER. Bowel/Bladder habits were Normal. He had no history of chest pain before but he is a smoker, 9-10 sticks per day for past 30 years. He occasionally consumed alcohol. He doesn’t give history of HTN, or Diabetes Mellitus. On Examination at ER: GC- patient conscious but in agony. Vitals- Blood pressure- 100/80 mmHg, Pulse= 64/minute, RR=32/min , Temperature=Normal Cardinal signs- JVP- raised Chest- Bilateral Normal Vesicular Breath Sound, No added sounds CVS- S1 and S2 Normal, No mumur P/A- soft, non-tender, no organomegaly ECG showed- ST-T chan...
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